PNEUMOCYSTIS-CARINII PNEUMONIA IN PATIENTS WITHOUT ACQUIRED-IMMUNODEFICIENCY-SYNDROME - ASSOCIATED ILLNESSES AND PRIOR CORTICOSTEROID-THERAPY

Objective: To determine the clinical spectrum of immunosuppressive con ditions and systemic corticosteroid therapy associated with the develo pment of Pneumocystis carinii pneumonia in a consecutive series of pat ients without acquired immunodeficiency syndrome (AIDS). Design: We re trospectively analyzed a consecutive series of 116 patients without AI DS who were assessed at Mayo Medical Center for a first episode of P. carinii pneumonia between 1985 and 1991. Methods: Medical records were examined to determine underlying immunosuppressive disorders, premorb id corticosteroid dosage and duration of therapy, associated infection s, and subsequent respiratory failure and in-hospital mortality. Resul ts: Conditions associated with first episode of P. carinii pneumonia w ere hematologic malignant disorders (30.2%), organ transplantation (25 .0%), inflammatory disorders (22.4%), solid tumors (12.9%), and miscel laneous conditions (9.5%). Regardless of the associated underlying dis ease, corticosteroids had been administered systemically in 105 patien ts (90.5%) within 1 month before the diagnosis of P. carinii pneumonia . The median daily corticosteroid dose was equivalent to 30 mg of pred nisone; however, 25% of patients had received as little as 16 mg of pr ednisone daily. The median duration of corticosteroid therapy was 12 w eeks before the development of pneumonia; however, P. carinii pneumoni a developed after 8 weeks or less of corticosteroid therapy in 25% of these patients. Respiratory failure occurred in 43%, and in-hospital m ortality was 34% for patients with P. carinii pneumonia in conditions other than AIDS. Conclusion: Although these results do not suggest tha t premorbid administration of corticosteroids is the only factor that contributes to the development of P. carinii pneumonia in these patien ts, they show that, in his large consecutive series, systemic corticos teroid therapy, even in moderate doses, was administered to most patie nts during the month preceding the onset of P. carinii pneumonia. Cons ideration should be given to instituting P. carinii prophylaxis (when not contraindicated) in patients for whom prolonged systemic corticost eroid therapy is prescribed.