Journal
INTERNAL MEDICINE
Volume 60, Issue 19, Pages 3143-3147Publisher
JAPAN SOC INTERNAL MEDICINE
DOI: 10.2169/internalmedicine.6577-20
Keywords
methotrexate; folinic acid; Pneumocystis jirovecii; Pneumocystis pneumonia; immune reconstitution inflammatory syndrome
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A 94-year-old woman with rheumatoid arthritis was referred to hospital due to fever and pancytopenia. Despite recovery from pancytopenia, she was diagnosed with PCP and possible immune reconstruction inflammatory syndrome.
A 94-year-old woman with rheumatoid arthritis who had been treated with low-dose methotrexate was referred to our hospital because of a 3-day history of a fever and pancytopenia. With a diagnosis of febrile neutropenia of unknown origin, empirical antibiotic treatment and folinic acid therapy were initiated. Despite a recovery from pancytopenia, the high fever remained, and dyspnea developed. She was clinically diagnosed with Pneumocystis jirovecii pneumonia (PCP) and successfully treated with trimethoprim/sulfamethoxazole and adjunctive corticosteroid therapy. Folinic acid treatment effectively brought about rapid immune recovery but might have led to a clinical manifestation of PCP resembling immune reconstruction inflammatory syndrome.
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