Pneumocystis jiroveccii as a cause of fever of unknown origin in a patient with dermatomyositis and pulmonary thromboembolism
Keywords:
PNEUMOCYSTIS JIROVECII, FEVER OF UNKNOWN ORIGIN, DERMATOMYOSITIS, PULMONARY EMBOLISMAbstract
Dermatomyositis (DM), the same as other auto-immune diseases, has been reported in several studies as a risk factor for a venous thromboembolic disease. Also, given immunity alterations caused by the disease itself, along with the immunodepression that characterizes treatment, these patients are likely to present infectious complications, many of them due to opportunistic germs such as Pneumocystis jirovecci (PJ).
Diagnostic criteria for fever of unknown origin (FUO) have been long discussed. Lately, new categories that are different to the classic FUO have been proposed, as is the one affecting immunodepressed patients, where both the etiology and presentation vary. Over 200 causes for FUO have been described, PJ being among them.
The clinical case of a female patient diagnosed with DM is described in the study, who, in spite of thromboprofilaxis presented a pulmonary thromboembolism episode. Likewise, during hospitalization, the patient evidenced FUO. After an extensive search, PJ was isolated and treatment was applied, resulting in an excellent clinical response.
References
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(2) Ramagopalan SV, Wotton CJ, Handel AE, Yeates D, Goldacre MJ. Risk of venous thromboembolism in people admitted to hospital with selected immune-mediated diseases: record-linkage study. BMC Med 2011; 9:1.
(3) Gaitonde SD, Ballou SP. Deep venous thrombosis in dermatomyositis. J Rheumatol 2008; 35(11):2288.
(4) Selva-O’Callaghan A, Fernández-Luque A, Martínez-Gómez X, Labirua-Iturburu A, Vilardell-Tarrés M. Venous thromboembolism in patients with dermatomyositis and polymyositis. Clin Exp Rheumatol 2011; 29(5):846–9.
(5) Zöller B, Li X, Sundquist J, Sundquist K. Autoimmune diseases and venous thromboembolism: a review of the literature. Am J Cardiovasc Dis 2012; 2(3):171–83.
(6) Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore) 1961; 40:1–30.
(7) Durack DT, Street AC. Fever of unknown origin-reexamined and redefined. Curr Clin Top Infect Dis 1991; 11:35–51.
(8) De Kleijn EM, Vandenbroucke JP, van der Meer JW. Fever of unknown origin (FUO). I A. prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. The Netherlands FUO Study Group. Medicine (Baltimore) 1997; 76(6):392–400.
(9) De Kleijn EM, van Lier HJ, van der Meer JW. Fever of unknown origin (FUO). II. Diagnostic procedures in a prospective multicenter study of 167 patients. The Netherlands FUO Study Group. Medicine (Baltimore) 1997; 76(6):401–14.
(10) Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults: 40 years on. J Intern Med 2003; 253(3):263–75.
(11) Vanderschueren S, Knockaert D, Adriaenssens T, Demey W, Durnez A, Blockmans D, et al. From prolonged febrile illness to fever of unknown origin: the challenge continues. Arch Intern Med 2003; 163(9):1033–41.
(12) Baicus C, Bolosiu HD, Tanasescu C, Baicus A. Fever of unknown origin-predictors of outcome. A prospective multicenter study on 164 patients. Eur J Intern Med 2003; 14(4):249–54.
(13) Arnow PM, Flaherty JP. Fever of unknown origin. Lancet 1997; 350(9077):575–80.
(14) Iikuni Y, Okada J, Kondo H, Kashiwazaki S. Current fever of unknown origin 1982-1992. Intern Med 1994; 33(2):67–73.
(15) Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med 2003; 163(5):545–51.
(16) Jani K, Mehta NJ. Pneumocystis carinii pneumonia presenting as a fever of unknown origin in a patient without AIDS. Hear Lung J Acute Crit Care 2002; 31(1):50–2.
(17) Ward MM, Donald F. Pneumocystis carinii pneumonia in patients with connective tissue diseases: the role of hospital experience in diagnosis and mortality. Arthritis Rheum 1999; 42(4):780–9.
(18) Godeau B, Coutant-Perronne V, Le Thi Huong D, Guillevin L, Magadur G, De Bandt M, et al. Pneumocystis carinii pneumonia in the course of connective tissue disease: report of 34 cases. J Rheumatol 1994; 21(2):246–51.
(19) Marie I, Hachulla E, Chérin P, Hellot M-F, Herson S, Levesque H, et al. Opportunistic infections in polymyositis and dermatomyositis. Arthritis Rheum 2005; 53(2):155–65.
(20) Sepkowitz KA. Pneumocystis carinii pneumonia in patients without AIDS. Clin Infect Dis 1993; 17(Suppl 2):S416–22.
(21) Yale SH, Limper AH. Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy. Mayo Clin Proc 1996; 71(1):5–13.
(22) Sepkowitz KA, Brown AE, Telzak EE, Gottlieb S, Armstrong D. Pneumocystis carinii pneumonia among patients without AIDS at a cancer hospital. JAMA 1992; 267(6):832–7.
(23) Rodriguez M, Fishman JA. Prevention of infection due to Pneumocystis spp. in human immunodeficiency virus-negative immunocompromised patients. Clin Microbiol Rev 2004; 17(4):770–82.
(24) Kadoya A, Okada J, Iikuni Y, Kondo H. Risk factors for Pneumocystis carinii pneumonia in patients with polymyositis/dermatomyositis or systemic lupus erythematosus. J Rheumatol 1996; 23(7):1186–8.
(25) Maldonado F, Patel RR, Iyer VN, Yi ES, Ryu JH. Are respiratory complications common causes of death in inflammatory myopathies? An autopsy study. Respirology 2012; 17(3):455–60.
(26) Marie I, Hachulla E, Chérin P, Dominique S, Hatron P-Y, Hellot M-F, et al. Interstitial lung disease in polymyositis and dermatomyositis. Arthritis Rheum 2002; 47(6):614–22.
(27) Kovacs JA, Hiemenz JW, Macher AM, Stover D, Murray HW, Shelhamer J, et al. Pneumocystis carinii pneumonia: a comparison between patients with the acquired immunodeficiency syndrome and patients with other immunodeficiencies. Ann Intern Med 1984; 100(5):663–71.
(28) Limper AH, Offord KP, Smith TF, Martin WJ. Pneumocystis carinii pneumonia. Differences in lung parasite number and inflammation in patients with and without AIDS. Am Rev Respir Dis 1989; 140(5):1204–9.
(29) Sepkowitz KA. Pneumocystis carinii pneumonia without acquired immunodeficiency syndrome: who should receive prophylaxis? Mayo Clin Proc 1996; 71(1):102–3.
(30) Thomas CF, Limper AH. Pneumocystis pneumonia. N Engl J Med 2004; 350(24):2487–98.
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Published
2015-09-30
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Méndez G, Andrade R, López M, Llambí L. Pneumocystis jiroveccii as a cause of fever of unknown origin in a patient with dermatomyositis and pulmonary thromboembolism. Rev. Méd. Urug. [Internet]. 2015 Sep. 30 [cited 2024 Sep. 7];31(3):214-20. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/208
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