Pneumocystis carinii pneumonia in systemic lupus erythematosus: A report of two cases

Patients with systemic lupus eythematosus (SLE) have increased susceptibili ty to infection by Pneumocystis carinii, but this condition has rarely been reported in Taiwan. Here, we describe two cases of patients with SLE who d eveloped Pneumocystis carinii pneumonia (PCP). The first patient was a 39-y ear-old woman presenting with fever and dyspnea that had lasted 2 weeks. Ch est roentgenography disclosed bilateral interstitial and alveolar infiltrat es. The second patient was a 22-year-old woman presenting with a 4-day hist ory of malaise, cough, dyspnea, and fever. She had concomitant Mycobacteriu m tuberculosis infection. Both patients had been treated with varying doses of corticosteroids and/or cytotoxic drugs within 4 months before presentat ion. Diagnosis was established based on the findings of bronchoalveolar lav age (BAL) and transbronchial lung biopsy (TBLB) Both patients received trim ethoprim-sulfamethoxazole (20 mg.kg(-1).d(-1) trimethoprim), but finally di ed of nosocomial septicemia (Acinetobacter baumanni and Pseudomonas aerugin osa bacteremia in one, P. aeruginosa bacteremia in the other). These two ca ses demonstrate that PCP should be included in the differential diagnosis o f patients with SLE presenting with pneumonic processes. In addition, a sec ond opportunistic pathogen should be suspected. Bronchoscopic examination s hould be performed if the diagnosis is not clear and should include TBLB an d BAL.