C T Berger1, V Greiff2, S John3, K F Koenig3, M B Bigler4, M Recher5, C Hess6, T Daikeler7. 1. Medical Outpatient Clinic, Department of Internal Medicine, and Translational Immunology, Department of Biomedicine, University Hospital Basel, Switzerland. 2. Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland. 3. Medical Outpatient Clinic, Department of Internal Medicine, University Hospital Basel, Switzerland. 4. Translational Immunology, Department of Biomedicine, University Hospital Basel, Switzerland. 5. Medical Outpatient Clinic, Department of Internal Medicine; and Immunodeficiency Lab, Department of Biomedicine, University Hospital Basel, Switzerland. 6. Medical Outpatient Clinic, Department of Internal Medicine; and Immunobiology Lab, Department of Biomedicine, University Hospital Basel, Switzerland. 7. Clinic of Rheumatology, University Hospital Basel, Switzerland.
Abstract
OBJECTIVES: Pneumocystis jiroveci pneumonia (PCP) is a life-threatening opportunistic infection. Few PCP cases in giant cell arteritis (GCA) have been described, but it remains unknown, which patients need PCP prophylaxis. METHODS: Sixty-two patients with GCA from a prospective cohort were studied to identify treatment-related predictors of PCP infection. RESULTS: Four PCP infections occurred, all in patients treated with methotrexate in addition to prednisone. Moreover, PCP is associated with higher cumulative PDN doses and severe lymphocytopenia (<400/μl). CONCLUSIONS: Our findings support PCP-prophylaxis in GCA patients who are treated with methotrexate and PDN, and need high prednisone doses to achieve remission, or develop severe lymphocytopenia.
OBJECTIVES:Pneumocystis jiroveci pneumonia (PCP) is a life-threatening opportunistic infection. Few PCP cases in giant cell arteritis (GCA) have been described, but it remains unknown, which patients need PCP prophylaxis. METHODS: Sixty-two patients with GCA from a prospective cohort were studied to identify treatment-related predictors of PCP infection. RESULTS: Four PCP infections occurred, all in patients treated with methotrexate in addition to prednisone. Moreover, PCP is associated with higher cumulative PDN doses and severe lymphocytopenia (<400/μl). CONCLUSIONS: Our findings support PCP-prophylaxis in GCA patients who are treated with methotrexate and PDN, and need high prednisone doses to achieve remission, or develop severe lymphocytopenia.
Authors: Sara Monti; Ana F Águeda; Raashid Ahmed Luqmani; Frank Buttgereit; Maria Cid; Christian Dejaco; Alfred Mahr; Cristina Ponte; Carlo Salvarani; Wolfgang Schmidt; Bernhard Hellmich Journal: RMD Open Date: 2019-09-16