July 14, 1997

Fulminant Pneumocystis carinii Pneumonia in 4 Patients With Dermatomyositis

Author Affiliations

From the Institut de Recherche sur la Peau and the Services de Dermatologie 1 (Drs Bachelez and Dubertret), Réanimation Médicale (Drs Schremmer and Schlemmer), and Dermatologie 2 (Dr Mouly), the Laboratoire de Parasitologie (Dr Sarfati), and the Laboratoire de Virologie (Dr Agbalika), Hôpital Saint-Louis, and the Service de Pneumologie, Hôpital Tenon (Drs Cadranel and Mayaud), Paris, France.

Arch Intern Med. 1997;157(13):1501-1503. doi:10.1001/archinte.1997.00440340145015

Between 1989 and 1996, 4 cases of Pneumocystis carinii pneumonia (PCP) were observed in patients seronegative for the human immunodeficiency virus who were receiving corticosteroid therapy for dermatomyositis in our institution. These cases were considered unusual in light of the short delay of their onset after initiation of immunosuppressive therapy and their fulminant course: 3 of these patients died of PCP occurring during the first month of treatment with prednisone. In all 4 patients lymphopenia was observed before the initiation of corticosteroid treatment and low CD4 and CD8 cell counts were evident at the time of PCP. These observations support the view of an increase in both the severity and incidence of PCP in patients without human immunodeficiency virus infection and question the need for a primary prophylaxis in patients with connective tissue diseases receiving high-dose corticosteroid therapy.

Arch Intern Med. 1997;157:1501-1503