Pneumocystis jiroveci pneumonia after total hip arthroplasty in a dermatomyositis patient:A case report  

作　　者：Mao Hong Zi-Yu Zhang Xiao-Wei Sun Wei-Guo Wang Qi-Dong Zhang Wan-Shou Guo 

机构地区：[1]Beijing University of Chinese Medicine,Beijing 100029,China [2]Department of Orthopaedic Surgery,Beijing Key Lab Immune-Mediated Inflammatory Diseases,China-Japan Friendship Hospital,Beijing 100029,China [3]Graduate School of Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100029,China

出　　处：《World Journal of Clinical Cases》2022年第10期3313-3320,共8页世界临床病例杂志

基　　金：Supported by National Natural Science Foundation of China,No. 81673776, and No. 82072494

摘　　要：BACKGROUND Pneumocystis jiroveci pneumonia(PJP)is a serious opportunistic infection that occurs mostly in patients with immunodeficiency and long-term immunosuppressive therapy.In non-human immunodeficiency virus-infected patients,the most important risk factor for PJP is the use of glucocorticoids in combination with other immunosuppressive treatments.The management of glucocorticoids during the perioperative period in patients with dermatomyositis requires special care.CASE SUMMARY We report a case of PJP in the perioperative period.A 61-year-old woman with a history of anti-melanoma differentiation-associated gene 5(MDA5)-positive dermatomyositis and interstitial pneumonia was administered with long-term oral methylprednisolone and cyclosporine.The patient underwent right total hip arthroplasty in the orthopaedic department for bilateral osteonecrosis of the femoral head.She was given intravenous drip hydrocortisone before anesthesia and on the first day after surgery and resumed oral methylprednisolone on the second postoperative day.On the fifth day after surgery,the patient suddenly developed dyspnea.The computed tomography scan showed diffuse grid shadows and ground glass shadows in both lungs.Polymerase chain reaction testing of bronchoalveolar lavage fluid was positive for Pneumocystis jiroveci.The patient was eventually diagnosed with PJP and was administered with oral trimethoprim-sulfamethoxazole.At the 6-mo review,there was no recurrence or progression.CONCLUSION Continued perioperative glucocorticoid use in patients with anti-MDA5-positive dermatomyositis may increase the risk of PJP.

关 键 词：Pneumocystis jiroveci pneumonia GLUCOCORTICOIDS Perioperative period DERMATOMYOSITIS Hypothalamic-pituitary-adrenal axis Case report 

分 类 号：R593.26[医药卫生—内科学] R563.1[医药卫生—临床医学]