Clinical and Radiological Features of Pneumocystis Pneumonia in Patients with Rheumatoid Arthritis, in comparison with Methotrexate Pneumonitis and Pneumocystis Pneumonia in Acquired Immunodeficiency Syndrome: A Multicenter Study

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概要

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• Objective To elucidate the clinical and radiological features of Pneumocystis pneumonia (PCP) in patients with rheumatoid arthritis (RA), compared with methotrexate (MTX) pneumonitis in RA and Pneumocystis pneumonia in acquired immunodeficiency syndrome (AIDS). Subjects and Methods Retrospective analysis of 14 PCP cases in RA (RA-PCP), 10 MTX pneumonitis cases in RA (MTX-P) and 11 PCP cases in AIDS (AIDS-PCP) from 9 centers in the Kanto area in the last 6 years. Results Compared with AIDS-PCP, both RA-PCP and MTX-P developed more rapidly, showing higher serum CRP and lower plasma β-D-glucan levels, and more severe oxygenation impairment. In most of the RA-PCP cases, a high dose of corticosteroid was administered as adjunctive therapy, resulting in a favorable outcome. The mortality was 14% in RA-PCP, 0% in AIDS-PCP and 0% in MTX-P cases. In RA-PCP patients the CD4 cell count showed only mild suppression, not reaching the predisposing level for PCP in HIV infection, suggesting that there are risk factors for RA-PCP other than immunosuppression. Radiologic analysis revealed some characteristic patterns of each disease. In MTX-P, diffuse homogeneous ground glass opacity (GGO) with sharp demarcation by interlobular septa (type A GGO) was found in 70%, while in AIDS-PCP diffuse, homogeneous or nonhomogeneous GGO without interlobular septal boundaries (type B GGO) was predominant (91%). In RA-PCP, type A GGO was found in 6 cases and type B GGO in 5 cases, showing the complex nature of this disease. Conclusion RA-PCP differed considerably from AIDS-PCP clinically and radiologically. Clinically it occurred without severe immunosuppression, and showed characteristic aspects, with more intense inflammation and less parasite burden. Radiologically it mimicked MTX-P in some cases sharing the conspicuous CT features of MTX-P, rendering the distinction of these two disorders difficult.

著者

• Kamatani Naoyuki

  Institute Of Rheumatology Aoyama Hospital Tokyo Women's Medical University

• Tateda Kazuhiro

  Department Of Microbiology And Infectious Disease Toho University School Of Medicine

• Sakai Fumikazu

  Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University

• Tokuda Hitoshi

  Department Of Internal Medicine Social Insurance Central General Hospital

• Hirakata Michito

  Department Of Internal Medicine Keio University School Of Medicine

• Dohi Makoto

  Department Of Allergy And Rheumatology Graduate School Of Medicine The University Of Tokyo

• Imamura Akifumi

  Departments Of Infectious Diseases Tokyo Metropolitan Komagome Hospital

• Takeuchi Tsutomu

  Department Of Astronomy Faculty Of Science Kyoto University

• Yamada Takashi

  Department Of Animal Science Graduate School Of Agricultural Science Kobe University

• Yamada Hidehiro

  Division Of Rheumatology And Allergology Department Of Internal Medicine St. Marianna University Sch

• GOTO HAJIME

  Department of Geriatrics, University of Tokyo Faculty of Medicine

• SAKAI Fumikazu

  Department of Diagnostic Radiology, International Medical Center, Saitama Medical University

• Johkoh Takeshi

  Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine

• Sugii Shoji

  Department of Rehabilitation, National Hospital Organization Sagamihara National Hospital

• Kikuchi Yoshimi

  Department of Infectious Diseases, Research Institute, International Medical Center of Japan

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