Pneumocystis jirovecii pneumonia after treatment ofacute exacerbation of asthma in a young adult patient

초록

Pneumocystis jirovecii pneumonia (PJP) is a potentially life-threatening infection that usually occurs in immunocompromised patients. Although some cases of PJP in asthma patients were reported in the 1990s, asthma is currently not a risk factor for PJP because the occurrence of PJP is extremely rare with Inhaled corticosteroids (ICS)-based treatment. We encountered a patient who developed PJP after systemic corticosteroids (SCS) treatment for acute asthma deterioration. This patient was a relatively young adult without previous evidence of immunosuppression. A 37-year-old man with asthma and hypertension was admitted due to fever and dyspnea. The patient had been under SCS therapy within the past 55 days for the treatment of acute asthma exacerbation. Despite systemic antibiotics treatment, he experienced persistent high fever and dyspnea, and was transferred to our hospital. Chest computed tomography (CT) revealed diffuse ground glass opacity in both lungs and multiseptated cysts in the left lower lobe. Analysis of bronchoalveolar lavage (BAL) fluid revealed mixed leukocytosis with predominant cytotoxic T-cell subsets. Polymerase chain reaction for P. jirovecci in BAL fluid showed positive results, and the patient showed progressive improvement after treatment with trimethoprim/sulfamethoxazole. This report highlights the need for more attention to the use of SCS in the treatment of acute asthma exacerbations even in young adult patients. PJP prophylaxis must be carefully considered when long-term treatment with SCS for asthma is anticipated.