Immune Reconstitution Inflammatory Syndrome-like Condition Associated with <i>Pneumocystis jirovecii</i> Pneumonia During Folinic Acid Treatment in a Rheumatoid Arthritis Patient

Abstract

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.

Pneumocystis jirovecii-associated immune reconstitution inflammatory syndrome-like phenomenon in a child with leukaemia: a case report and literature review

“…IRIS-like phenomena can occur in non-AIDS immunosuppressed hosts such as patients with connective tissue disease and organ transplant patients receiving immunosuppressive therapy [5]. But the data is rare, especially in the pediatric patient.…”