Pneumocystis jiroveci pneumonia following rituximab treatment in Wegener's granulomatosis
Version of Record online: 25 JUN 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 11, pages 1661–1664, November 2010
How to Cite
Hugle, B., Solomon, M., Harvey, E., James, A., Wadhwa, A., Amin, R., Bell-Peter, A. and Benseler, S. (2010), Pneumocystis jiroveci pneumonia following rituximab treatment in Wegener's granulomatosis. Arthritis Care Res, 62: 1661–1664. doi: 10.1002/acr.20279
- Issue online: 2 NOV 2010
- Version of Record online: 25 JUN 2010
- Manuscript Accepted: 17 JUN 2010
- Manuscript Received: 30 MAR 2010
Wegener's granulomatosis (WG) is a devastating small-vessel vasculitis in children. Standard treatment consists of immunosuppressive medications with cyclophosphamide potentially associated with significant infectious side effects, including Pneumocystis jiroveci pneumonia (PCP). Recently, rituximab, a monoclonal antibody against B cells, has successfully been used in refractory disease.
We describe the first pediatric patient with refractory WG with sinus and lung disease who developed PCP 6 months after treatment with rituximab, while being treated with methotrexate and prednisone. This 9-year-old child had no CD20+ B cells at time of infection, with normal lymphocyte and CD4 counts.
This study provides a review of the published literature, including current protocols, which suggest chemoprophylaxis only in WG patients receiving T cell–targeted immunosuppression such as cyclophosphamide. However, clinical and laboratory evidence points toward a possible role of B cells in the defense against PCP.
Routine PCP chemoprophylaxis should be strongly considered in patients with WG treated with rituximab.