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

Hitoshi Tokuda, Fumikazu Sakai, Hidehiro Yamada, Takeshi Johkoh, Akifumi Imamura, Makoto Dohi, Michito Hirakata, Takashi Yamada, Naoyuki Kamatani, Yoshimi Kikuchi, Shoji Sugii, Tsutomu Takeuchi, Kazuhiro Tateda, Hajime Goto

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)915-923
Number of pages9
JournalInternal Medicine
Volume47
Issue number10
DOIs
Publication statusPublished - 2008

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Pneumocystis Pneumonia
Methotrexate
Multicenter Studies
Rheumatoid Arthritis
Pneumonia
Acquired Immunodeficiency Syndrome
Glass
Immunosuppression

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

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. / Tokuda, Hitoshi; Sakai, Fumikazu; Yamada, Hidehiro; Johkoh, Takeshi; Imamura, Akifumi; Dohi, Makoto; Hirakata, Michito; Yamada, Takashi; Kamatani, Naoyuki; Kikuchi, Yoshimi; Sugii, Shoji; Takeuchi, Tsutomu; Tateda, Kazuhiro; Goto, Hajime.

In: Internal Medicine, Vol. 47, No. 10, 2008, p. 915-923.

Research output: Contribution to journalArticle

Tokuda, Hitoshi ; Sakai, Fumikazu ; Yamada, Hidehiro ; Johkoh, Takeshi ; Imamura, Akifumi ; Dohi, Makoto ; Hirakata, Michito ; Yamada, Takashi ; Kamatani, Naoyuki ; Kikuchi, Yoshimi ; Sugii, Shoji ; Takeuchi, Tsutomu ; Tateda, Kazuhiro ; Goto, Hajime. / 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. In: Internal Medicine. 2008 ; Vol. 47, No. 10. pp. 915-923.
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abstract = "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.",
author = "Hitoshi Tokuda and Fumikazu Sakai and Hidehiro Yamada and Takeshi Johkoh and Akifumi Imamura and Makoto Dohi and Michito Hirakata and Takashi Yamada and Naoyuki Kamatani and Yoshimi Kikuchi and Shoji Sugii and Tsutomu Takeuchi and Kazuhiro Tateda and Hajime Goto",
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T1 - Clinical and radiological features of pneumocystis pneumonia in patients with rheumatoid arthritis, in comparison with methotrexate pneumonitis and pneumocystis pneumonia in acquired immunodeficiency syndrome

T2 - A multicenter study

AU - Tokuda, Hitoshi

AU - Sakai, Fumikazu

AU - Yamada, Hidehiro

AU - Johkoh, Takeshi

AU - Imamura, Akifumi

AU - Dohi, Makoto

AU - Hirakata, Michito

AU - Yamada, Takashi

AU - Kamatani, Naoyuki

AU - Kikuchi, Yoshimi

AU - Sugii, Shoji

AU - Takeuchi, Tsutomu

AU - Tateda, Kazuhiro

AU - Goto, Hajime

PY - 2008

Y1 - 2008

N2 - 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.

AB - 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.

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