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Article
September 1987

Cyclosporine Therapy and Refractory Pneumocystis carinii PneumoniaA Potential Association

Author Affiliations

From the Departments of Medicine (Drs Franson and Lemann), Surgery (Drs Kauffman, Adams, and Cabrera), and Infection Control (Ms Hanacik), Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, Milwaukee. Dr Franson is now with Lilly Research Laboratories, Indianapolis.

Arch Surg. 1987;122(9):1034-1035. doi:10.1001/archsurg.1987.01400210072010
Abstract

• In surveillance of 75 patients receiving renal transplants in 1984 at our Institution, five cases of Pneumocystis carinii pneumonia were detected. All five cases occurred in a subgroup of 11 patients who had received cyclosporine. A retrospective epidemiologic survey of the infected patients revealed all five were heterosexual white men with onset of Pneumocystis pneumonia two to six months after cadaveric transplantation. All received cyclosporine and corticosteroids, and four of five patients also received azathioprine; none was neutropenic or had evidence of concurrent cytomegalovirus infection. Only one of these patients responded to therapy with sulfamethoxazole and trimethoprim, one patient responded to pentamidine therapy, and the remaining three patients died. Cyclosporine use may be related to development of Pneumocystis infections that are refractory to conventional antiprotozoal therapy, and transplantation programs should closely survey patients for such complications.

(Arch Surg 1987;122:1034-1035)

References
1.
Hess AD, Tutschka PJ:  Effects of cyclosporine A on human lymphocyte responses in vitro: I. CsA allows for the expression of alloantigen-activated suppressor cells while preferentially inhibiting the induction of cytolytic effector lymphocytes in MLR . J Immunol 1980;124:2601-2608.
2.
Bunjes D, Hardt C, Rollinghoff M, et al:  Cyclosporine A mediates immunosuppression of primary cytotoxic T cell responses by impairing the release of interleukin-1 and interleukin-2 . Eur J Immunol 1981;11:657-661.Article
3.
Dummer JS, Hardy AM, Poorsattar A, et al:  Early infection in kidney, heart and liver transplant recipients on cyclosporine . Transplantation 1984;37:259-267.
4.
Hardy AM, Wajszczuk CP, Suffredin AF, et al:  Pneumocystis carinii pneumonia in renal-transplant recipients treated with cyclosporine and steroids . J Infect Dis 1984;149:143-147.Article
5.
Frenkel JK, Good JT, Schultz JA:  Latent Pneumocystis infection in rats, relapse and chemotherapy . Lab Invest 1966;15:1559-1577.
6.
Hughes WT, Smith B:  Provocation of infection due to Pneumocystis carinii by cyclosporine A . J Infect Dis 1982;145:767.Article
7.
Bradley PP, Warden GD, Maxwell JG, et al:  Neutropenia and thrombocytopenia in renal allograft recipients treated with trimethoprim-sulfamethoxazole . Ann Intern Med 1980;93:560-562.Article
8.
Lawson DH, Jick H:  Adverse reactions to co-trimoxazole in hospitalized medical patients . Am J Med Sci 1978;275:53-57.Article
9.
Berglund F, Killander J, Pompeius R:  Effect of trimethoprim-sulfamethoxazole on the renal excretion of creatinine in man . J Urol 1975;114: 802-808.
10.
Kalowski S, Nanra RS, Mathew TH, et al:  Deterioration in renal function in association with co-trimoxazole therapy . Lancet 1973;1:394-397.Article
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