Immune Reconstitution Inflammatory Syndrome Associated with <i>Pneumocystis jirovecii</i> Pneumonia and Cytomegalovirus Colitis in a Patient with Rheumatoid Arthritis

Abstract

A 68-year-old woman presenting with rheumatoid arthritis was admitted due to pancytopenia caused by methotrexate. Pneumocystis jirovecii pneumonia was diagnosed based on the abnormal shadows observed on chest computed tomography, the presence of serum β-D-glucan, and positive P. jirovecii-DNA results in a sputum analysis. Subsequently, after treatment with leucovorin and trimethoprim-sulfamethoxazole, lung consolidation was found to be aggravated, along with a rapidly increasing leukocyte count. In addition, cytomegalovirus colitis was diagnosed. Both conditions were associated with immune reconstitution inflammatory syndrome caused by recovery from leukopenia. The patient was successfully treated with intravenous methylprednisolone pulse therapy and ganciclovir.

Rare case of immune mediated cutaneous leucoclastic vasculitis with pancytopenia in a rheumatoid arthritis patient with chronic cytomegalovirus infection

“…This case highlights the potential risks of immunosuppression in RA, stressing the importance of careful monitoring and possibly preemptive measures during immunosuppressive therapy. 6 A report covered the reactivation of cytomegalovirus in a patient with refractory rheumatoid vasculitis, considered a manifestation of immune reconstitution inflammatory syndrome (IRIS). It discusses the impact of adjusting immunosuppressive therapy on the course of both vasculitis and viral reactivation.…”