A Case of Pneumocystis Pneumonia Developed During Rheumatoid Arthritis Treatment With Methotrexate and Golimumab

TL;DR

An elderly rheumatoid arthritis patient on methotrexate and golimumab developed severe Pneumocystis pneumonia, highlighting infection risks in immunosuppressed individuals.

Contribution

Reports a rare case of Pneumocystis pneumonia in RA patients treated with methotrexate and golimumab, emphasizing infection risks.

Findings

An 87-year-old RA patient on methotrexate and golimumab developed severe Pneumocystis pneumonia.

High-flow oxygen and trimethoprim/sulfamethoxazole improved the patient's condition.

The case highlights the increased infection risk with immunosuppressive therapies like methotrexate and TNF inhibitors.

Abstract

Here, we report a case of an 87-year-old female patient with rheumatoid arthritis (RA) treated with methotrexate (MTX) and golimumab who developed severe pneumocystis pneumonia (PCP), also known as Pneumocystis jirovecii pneumonia. The patient presented with chief complaints of dyspnea on exertion, dry cough, and fatigue. A high-resolution chest CT scan revealed diffuse, unevenly distributed ground-glass opacities throughout both lungs. The patient was clinically diagnosed with PCP based on the clinical settings, imaging, and a high level of serum β-D-glucan. While the patient required high-flow oxygen therapy, low-dose trimethoprim/sulfamethoxazole and corticosteroid therapy improved her condition, and the patient was discharged on day 25. Although to our knowledge no case report has been published regarding PCP in patients with RA treated with golimumab, this case emphasizes the importance of attention to opportunistic infections in elderly patients receiving immunosuppressive therapy. MTX use alongside tumor necrosis factor inhibitors like golimumab may increase the risk of serious infections such as PCP. The case underscores the necessity of prophylactic measures and early intervention for PCP, highlighting the delicate balance between immunosuppression benefits and infection risks in RA management.

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