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Table 1 Summary of literature reported cases of HIV-negative immunocompromised patients with PCP manifested as IRD

From: The unmasking of Pneumocystis jiroveci pneumonia during reversal of immunosuppression: case reports and literature review

Case [Ref.] Sex/Age (years) Underlying disease (s) Reduction of IS level before symptoms onset of IRD Symptoms & signs at IRD; change of lymphocyte count before & during IRD (if mentioned) Treatment, clinical progress & outcome
1–7 [22] M/F: 4:3 Median age 12, range 2–25 Acute leukemia in remission (4), acute leukemia in relapse (1), Hodgkin's disease (1), embryonal carcinoma of testes (1) P ↓ from 100 mg to 40 mg over 3 weeks in 1 patients;
In another 6 patients, P stopped in a median of 10.5 days, range (1–21 days) before symptoms onset
NM Died (5) & survived (2)
8–15 [23] NM Primary brain tumour (8) Dexa ↓ over a median of 12.5 days, range (1–63 days) Fever (4), nonproductive cough (4), productive cough (2), dyspnoea (7), chest pain (4); CXR: bilateral infiltrates (3), diffuse infiltrates (3), focal infiltrates (1), clear (1) Died (3) & survived (5)
16 [24] M/55 Primary brain tumour (glioblastoma multiforme) Dexa ↓ from 16 mg qd to 2 mg qd over 8 weeks Intermittent fever, nonproductive cough, progressive dyspnoea; CXR: bilateral interstitial infiltrates; PaO2 (RA): 51 mmHg Treated with intravenous cotrimoxazole; survived
17 [24] F/74 Primary brain tumour (meningioma) Dexa ↓ from 12 mg qd to 4 mg qd over 2 weeks Intermittent fever, nonproductive cough; CXR: bilateral interstitial infiltrates; PaO2 (RA): 45 mmHg Treated with intravenous cotrimoxazole; survived
18 [24] M/50 Primary brain tumour (astrocytoma) Dexa ↓ from 16 mg qd to 1 mg qd over 8 weeks Fever, nonproductive cough, dyspnoea; CXR: bilateral interstitial infiltrates; PaO2 (RA): 73 mmHg Treated with intravenous cotrimoxazole; mechanical ventilation; survived
19 [24] M/75 Primary brain tumour (glioblastoma multiforme) Dexa ↓ from 16 mg qd to 4 mg qd over 6 weeks Fever, nonproductive cough, bloody diarrhoea; CXR: clear; PaO2 (RA): 89 mmHg Treated with intravenous cotrimoxazole; survived
20 [25] M/24 ACTH- producing metastatic bronchial carcinoid Serum cortisol ↓ from 138 pg/ml to 18 pg/ml over 54 days Fever, nonproductive cough, weakness, sweats; CXR: bilateral fluffy infiltrates; PaO2 (RA): 40 mmHg Treated with intravenous cotrimoxazole; mechanical ventilation; died of malignancy
21 [26] F/38 Endogenous Cushing's syndrome Metyrapone 750 mg qd added 1 day before symptoms onset Productive cough, dyspnoea; CXR: right lower upper lobe infiltrates; PaO2 (RA):31 mmHg Treated with intravenous cotrimoxazole; mechanical ventilation; died
22–28 [32] M/F 4:3 Mean (SD) age 53.1 (13.6) ITP (2), GN (2), bullous pemphigoid (1), endogenous Cushing's syndrome (1), and renal transplantation (1) Reduction of steroid but details of tailing regimen was not mentioned An upsurge of lymphocyte counts from the reduction of immunosuppression (median 300/μL, range 290 to 740/μL) to the onset of IRD (median 1500/μL, range 600 to 5620/μL) Treated with steroid as anti-PJP therapy in 7 (100%); mechanical ventilation in 6 (85.7%), died in 3 (42.9%)
29 M/33 (Our patient) Systemic lupus erythematosus/dermato-myositis overlapping syndrome P ↓ from 45 mg to 15 mg over 4 days Fever, dyspnoea; CXR: increased perihilar infilitrates; lymphocyte count increased from 600 to 1300/μL Treated with intravenous cotrimoxazole and steroid; survived
  1. Note. Aza, azathioprine; CXR, chest radiograph; Dexa, dexamethasone; IRD, immunorestitution disease; ITP, immune thrombocytopenia purpura; IS, immunosuppression; GN, glomerulonephritis; P, prednisolone; PCP, Pneumocystis jiroveci pneumonia; RA, room air.
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