Objective To investigate the clinical features of
patients with
inflammatory bowel disease (IBD) complicated with
Pneumocystis Jiroveci Pneumonia (PJP).
Methods We retrospectively analyzed the clinical data of 5
patients who were hospitalized in
Peking Union Medical College
Hospital from January 2012 to July 2017 for
treatment of IBD complicated with PJP. Demographic characteristics,clinical manifestations,
treatments,and outcomes were descriptively analyzed. Results Of these five
patients,four had
ulcerative colitis (UC) and one had
Crohn's disease (CD). All
patients were
males,with an average age of (61.8±1.9) years. All
patients were in active
disease status and had symptoms including
cough and
suffocation. Three
patients had
hypoxemia,among whom two developed type 1
respiratory failure. Three
patients were treated with immunosuppressive medications (
corticosteroids and/or
immunosuppressant drugs) before the
diagnosis of PJP.
Lymphocyte counts in three
patients were less than 0.6×10/L. CD4+
T cells in two
patients were less than 200×10/L. Four
patients had elevated
serum cytomegalovirus DNA. The level of β-D-
glucan was elevated in four
patients.
Chest CT showed bilateral diffuse ground
glass opacification. PJP-
DNA was positive in
sputum or
bronchoalveolar lavage fluid in all
patients. Two
patients with type 1
respiratory failure required invasive
mechanical ventilation. All
patients received
trimethoprim-sulfamethoxazole and
methylprednisolone treatment. Four
patients recovered completely and one died. Conclusion
Elderly (
aged>55 years) IBD
patients who are receiving immune-suppressive
therapy or with decreased peripheral
blood lymphocyte count are at higher
risk of PJP.