DOI QR코드

DOI QR Code

Immune Reconstitution Inflammatory Syndrome-Like Reaction During the Treatment of Pneumocystis jirovecii Pneumonia in an Infant With Severe Combined Immunodeficiency

  • Ching-Yu Lin (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Sung-Min Lim (Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine) ;
  • Soo-Yeon Kim (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Seung-Min Hahn (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Jong-Gyun Ahn (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Ji-Man Kang (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine)
  • Received : 2023.08.18
  • Accepted : 2023.12.20
  • Published : 2024.04.25

Abstract

The effectiveness of corticosteroids in preventing immune reconstitution inflammatory syndrome in non-human immunodeficiency viruses Pneumocystis carinii pneumonia (PCP) patients, such as severe combined immunodeficiency (SCID) patients, is controversial. We experienced a paradoxical reaction during severe PCP treatment in a SCID infant, which responded well to adjuvant corticosteroids.

인체면역결핍바이러스 감염자의 페포자충폐렴 치료에 있어 보조적 스테로이드 치료의 효용성은 잘 알려진데 반해, 비인체면역결핍바이러스 면역저하자에서의 페포자충폐렴 치료에 있어서의 보조적 스테로이드 치료의 효용성은 논란의 여지가 있다. 본 연구자들은 비인체면역결핍바이러스 면역저하자인 중증복합면역결핍증 영아에서 이환된 중증페포자충폐렴를 치료하던 중 면역재구성염증증후군 유사현상을 관찰하였으며, 보조적 스테로이드 치료에 잘 반응하였기에 이를 보고하는 바이다.

Keywords

Acknowledgement

We wish to thank the patient and his family for their participation in this study.

References

  1. Lei JY, Chen H, Zhou DH, Xu LH, Fang JP, Mai YG. Pneumocystis jirovecii-associated immune reconstitution inflammatory syndrome-like phenomenon in a child with leukaemia: a case report and literature review. BMC Pediatr 2022;22:410.
  2. Martin-Blondel G, Mars LT, Liblau RS. Pathogenesis of the immune reconstitution inflammatory syndrome in HIV-infected patients. Curr Opin Infect Dis 2012;25:312-20. https://doi.org/10.1097/QCO.0b013e328352b664
  3. Ewald H, Raatz H, Boscacci R, Furrer H, Bucher HC, Briel M. Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV infection. Cochrane Database Syst Rev 2015;2015:CD006150.
  4. Siberry GK, Abzug MJ, Nachman S, Brady MT, Dominguez KL, Handelsman E, et al. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. Pediatr Infect Dis J 2013;32 Suppl 2:i-KK4.
  5. Maschmeyer G, Helweg-Larsen J, Pagano L, Robin C, Cordonnier C, Schellongowski P, et al. ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients. J Antimicrob Chemother 2016;71:2405-13. https://doi.org/10.1093/jac/dkw158
  6. Lundgren IS, Englund JA, Burroughs LM, Torgerson TR, Skoda-Smith S. Outcomes and duration of Pneumocystis jirovecii pneumonia therapy in infants with severe combined immunodeficiency. Pediatr Infect Dis J 2012;31:95-7. https://doi.org/10.1097/INF.0b013e31822db772
  7. Kim KR, Kim JM, Kang JM, Kim YJ. Pneumocystis jirovecii pneumonia in pediatric patients: an analysis of 15 confirmed consecutive cases during 14 years. Korean J Pediatr 2016;59:252-5. https://doi.org/10.3345/kjp.2016.59.6.252
  8. Nandakumar V, Hebrink D, Jenson P, Kottom T, Limper AH. Differential macrophage polarization from pneumocystis in immunocompetent and immunosuppressed hosts: potential adjunctive therapy during pneumonia. Infect Immun 2017;85:e00939-16.