Pneumocystis jirovecii pneumonia with diffuse alveolar hemorrhage in a patient with rheumatoid arthritis receiving infliximab

Abstract

Pneumocystis jirovecii pneumonia (PCP) is an opportunistic pulmonary infection in immunosuppressed hosts such as human immunodeficiency virus-positive or organ transplant patients. An increasing number of PCP cases have been reported among patients with rheumatoid arthritis (RA) treated with disease-modifying anti-rheumatic drugs. While PCP with diffuse alveolar hemorrhage (DAH) has been mostly documented in human immunodeficiency virus-positive patients, it has been rarely reported in patients with RA. Herein, we report a case of PCP with DAH in a female patient with RA who was treated with infliximab. We confirmed PCP and DAH by bronchoalveolar lavage, and the patient was successfully treated with trimethoprim-sulfamethoxazole. PCP should be considered in the differential diagnosis of DAH in RA patients receiving infliximab.