Letter to the Editor

Pneumocystis carinii jiroveci Pneumonia Following Infliximab Infusion for Crohn Disease: Emphasis on Prophylaxis

Authors: Kanan Sharma, MD, Pallavi Rao, MD, Padmini Krishnamurthy, MD, Syed Ahsan Ali, MD, Gregory Beck, MD


To the Editor:

Pneumocystis carinii pneumonia (PCP) is known to be associated with immunodeficiency states such as AIDS, malignancies and chemotherapy. Lately the occurrence of PCP has increased as the indications for use of immunosuppressive/immunomodulator therapies have broadened.1,2 PCP following infliximab therapy for Crohn disease, although still uncommon, is increasing in occurrence. Although recommendations for prophylaxis for PCP are well known in HIV patients, there are no guidelines for prophylaxis in non-HIV patients. There has been mention of considering prophylaxis in patients who are receiving immunosuppressive medications or who have an underlying acquired or inherited immunodeficiency.3 In this letter, we describe a case of PCP following the second dose of infliximab infusion in a woman with Crohn disease.

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1. Varthalitis I, Aoun M, Daneau D, et al. Pneumocystis carinii pneumonia in patients with cancer: an increasing incidence. Cancer 1993;71:481–485.
2. Mansharamani NG, Garland R, Delaney D, et al. Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995: comparison of HIV-associated cases to other immunocompromised states. Chest 2000;118:704–711.
3. Thomas CF Jr, Limper AH. Pneumocystis pneumonia. N Engl J Med 2004;350:2487–2498.
4. Sepkowitz KA. Opportunistic infections in patients with and patients without acquired immunodeficiency syndrome. Clin Infect Dis 2002;34:1098–107. [Erratum, Clin Infect Dis2002:34:1293].
5. Food and Drug Administration. Safety update on TNFα antagonist: Infliximab and etanercept. Food and Drug Administration, Center for Biologics Evaluation and Research, Arthritis Advisory Committee Meeting, August 17, 2001.