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- Naoki Arakawa, Kazuo Eguchi, Yuki Nakamura, Yuta Tsukahara, Youhei Koushima, and Hidekazu Matsushima.
- Department of General Internal Medicine, Saitama Red Cross Hospital, Japan.
- Intern. Med. 2021 Oct 1; 60 (19): 3143-3147.
AbstractA 94-year-old woman with rheumatoid arthritis who had been treated with low-dose methotrexate was referred to our hospital because of a 3-day history of a fever and pancytopenia. With a diagnosis of febrile neutropenia of unknown origin, empirical antibiotic treatment and folinic acid therapy were initiated. Despite a recovery from pancytopenia, the high fever remained, and dyspnea developed. She was clinically diagnosed with Pneumocystis jirovecii pneumonia (PCP) and successfully treated with trimethoprim/sulfamethoxazole and adjunctive corticosteroid therapy. Folinic acid treatment effectively brought about rapid immune recovery but might have led to a clinical manifestation of PCP resembling immune reconstruction inflammatory syndrome.
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