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Pneumocystis jiroveci (carinii) Pneumonia After Infliximab Therapy: A Review of 84 Cases

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Abstract

Anti-tumor necrosis factor-α therapy, infliximab, has become an established effective therapy for Crohn's disease and rheumatoid arthritis. However, infliximab has been associated with various opportunistic pathogens such as tuberculosis, histoplasmosis, listeriosis, aspergillosis, and Pneumocystis jiroveci (carinii) pneumonia. We reviewed the FDA Adverse Event Reporting System for cases of Pneumocystis associated with infliximab use from January 1998 through December 2003. The database revealed 84 cases of PCP following infliximab therapy. Concomitant immunosuppressive medications included methotrexate, prednisone, azathioprine, 6-mercaptopurine, and cyclosporine. Mean time between infliximab infusion and onset of symptoms of pneumonia, when reported, was 21 days (±18 days; n=40). Twenty-three of the 84 (27%) patients died. The use of infliximab is associated with PCP infection. Further, the mortality rate for Pneumocystis following the use of infliximab is significant. The potential for severe disease, mortality, and often subtle presentation of these infections warrant close follow-up and careful monitoring after therapy.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

    Nirmal Kaur

  2. Division of Gastroenterology, Department of Medicine, VA Upstate New York, State University of New York at Buffalo School of Medicine, Buffalo, New York, 14215, USA

    Thomas C. Mahl

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  1. Nirmal Kaur
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  2. Thomas C. Mahl
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Correspondence to Thomas C. Mahl.

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Kaur, N., Mahl, T.C. Pneumocystis jiroveci (carinii) Pneumonia After Infliximab Therapy: A Review of 84 Cases. Dig Dis Sci 52, 1481–1484 (2007). https://doi.org/10.1007/s10620-006-9250-x

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  • DOI: https://doi.org/10.1007/s10620-006-9250-x

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