PNEUMOCYSTIS JIROVECIL PNEUMONIA (PJP)IN NON-HIV INFECTED PATIENTS WITH SOLID TUMOR

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Abstract

Backgroud

There is a growing number of Pneumocystis jirovecil pneumonia (PJP) in non-HIV-infected population. Although it is a treatable infection, it can be fatal in severe cases. The purpose of this study was to describe the clinical characteristics and mortality of PJP in solid tumor patients.

Methods

The medical records of all patients with solid tumor in Department of Medical Oncology at Kameda Medical Center between 2008 and 2011 were retrospectively reviewed. The clinical and laboratory findings of the patients with a first proven episode of PJP were extracted. The diagnosis was made by microscopy with Diff-Quik staining and/or polymerase chain reaction of induced sputum or bronchoalveolar lavage fluid.

Result

Among the 1481 patients, there were five documented cases of PJP. The median age was 70 (range 49–80). The underlying malignancies were lung cancer (two), gastric cancer (one), rectal cancer (one) and thymic carcinoma (one). Four patients had dyspnea, and one had fever. The median duration from the diagnosis of malignancy and the diagnosis of PJP was 10 months (range 3–32). The patients performance statuses (number) were 1 (3), 3 (1) and 4 (1), respectively. The median lymphocyte count was 1155/mm3. β-D-glucan levels were elevated in four patients (median level: 26 pg/ml). Within 30 days before the diagnosis of PJP, four of five patients were receiving corticosteroids (dexamethasone) at median cumulative 30-day dose of 36 mg. No patient was on PJP prophylaxis. One patient died of PJP and others recovered. The radiographic findings of all patients were diffuse bilateral interstitial infiltrates.

Conclusion

The incidence of PJP in solid tumor patients is higher than expected. Although the number of cases was small, the mortality rate was 20% among the documented cases. This study suggests the importance of PJP prophylaxis in patients with solid tumor who are receiving corticosteroid and of prompt diagnosis of PJP in such patients with diffuse pulmonary infiltrates.

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