Zain Majid
1*, Afshan Hussain
2, Hafsa Jawaid
2, Shoaib Ahmed
1, Saima Ahmed
1, Mohammad Mubarak
31 Department of Internal Medicine, Sind Institute of Urology and Transplantation, Karachi, Pakistan
2 Dow Medical College, Civil Hospital Karachi, Pakistan
3 Department of Histopathology, Sind Institute of Urology and Transplantation, Karachi, Pakistan
Abstract
Patients with lupus nephritis on immunosuppressive therapy are at an increased risk of
opportunistic infections. Pneumocystis pneumonia infection though rare, does occur
in such patients and is usually missed on commonly conducted investigations. Hence
physicians must suspect it when clinical signs and symptoms do not improve in these patients
despite being on treatment. being a diagnosed case of lupus nephritis (renal biopsy proven;
immunofluorescence microscopy (IMF) showed full house positivity while serum serology
revealing decreased levels of both serum C3 and C4, a strong positive ANA and rheumatoid
factor). She had previously received three doses of cyclophosphamide. She was referred to us
with the complains of pedal edema, fever and cough. Her examination revealed bilateral lung
crepitations. Chest X-ray showed well defined shadows adjacent to the lung hilum with air
bronchogram. In her bronchoalveolar lavage, a few pseudohyphae along with a positive test
for Pneumocystis jiroveci pneumonia (PCP) was detected. Hence, the patient was treated for
PCP pneumonia with sulfamethoxazole and trimethoprim. After completion of the course her
condition had improved significantly and she was later on discharged.
Implication for health policy/practice/research/medical education:
Patients with lupus nephritis on immunosuppressive therapy are at an increased risk of opportunistic infections. Pneumocystis
pneumonia infection though rare, does occur in such patients and is usually missed on commonly conducted investigations.
Hence physicians must suspect it when clinical signs and symptoms do not improve in these patients despite being on treatment.
Please cite this paper as: Majid Z, Hussain A, Jawaid H, Ahmed S, Ahmed S, Mubarak M. Pneumocystis pneumonia in a
patient with lupus nephritis. J Nephropharmacol. 2017;7(1):40-42. DOI: 10.15171/npj.2018.09.