Pneumocystis Jirovecii Pneumonia in a Patient with Anti-N-Methyl-D-Aspartate Receptor Postherpetic Encephalitis

Abstract

Anti-N-methyl-D-aspartate receptor encephalitis is a neuroimmunologic disorder that has been increasingly diagnosed during the past 5 years. It provokes a predictable syndrome treated with several immunomodulatory agents, such as corticosteroids and/or biologics. We managed a child with this disease who developed Pneumocystis jirovecii pneumonia as a direct infectious complication of the use of rituximab.

Pneumocystis jirovecii Pneumonia in Neurologic Disorders

“…19 Much of the warning for neurologists to consider PJP prophylaxis arose from isolated reports of various nononcologic neurologic patients developing PJP. 4,7,8 In our series, most patients with PJP with primary neurologic disorders had underlying brain or other solid organ/ hematologic malignancy, which was previously known to be associated with an increased risk of PJP. 2,5,12,20 Primary and metastatic brain malignancies are both risk factors for the development of PJP, with varying incidences reported of 0.3%-6%.…”

“…19 Much of the warning for neurologists to consider PJP prophylaxis arose from isolated reports of various nononcologic neurologic patients developing PJP. 4,7,8…”

“…1 PJP is well known to affect patients infected with HIV and increasingly reported in immunocompromised patients such as solid organ and hematologic transplant recipients, patients on chemotherapy, or patients receiving immunotherapy for inflammatory/autoimmune conditions. 1,2 PJP has been described in patients with a variety of CNS and peripheral nervous system (PNS) disorders, 3–8 and its occurrence has led to the proposal that neurologists should consider prescribing PJP prophylaxis in selected patients. 9 However, the true incidence of PJP in patients with underlying neurologic conditions is not well established, and there has been no risk-benefit assessment for PJP prophylactic regimen in neurologic disorders.…”

Herpes simplex virus‐induced anti‐N‐methyl‐d‐aspartate receptor encephalitis: a systematic literature review with analysis of 43 cases

“…Our literature search led to the identification of 20 articles, published between 2013 and 2016, reporting a total of 42 patients who experienced biphasic disease with HSE followed by HSV‐induced anti‐NMDAR encephalitis . The full text of all articles was available.…”

“…Our literature search led to the identification of 20 articles, published between 2013 and 2016, reporting a total of 42 patients who experienced biphasic disease with HSE followed by HSV-induced anti-NMDAR encephalitis. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The full text of all articles was available. With the addition of our case, a total of 43 patients with biphasic disease with HSE followed by HSV-induced anti-NMDAR encephalitis were identified (31 children).…”