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Pneumocystis jirovecii pneumonia in patients treated with rituximab for systemic diseases: Report of 11 cases and review of the literature

Published:November 30, 2017DOI:https://doi.org/10.1016/j.ejim.2017.11.014
      During the last decades, the number of Pneumocystis jirovecii pneumonia (PJP) has grown in HIV-negative patients due to the increasing use of organ transplantation, immunosuppressive drugs and targeted therapies [
      • Wickramasekaran R.N.
      • Jewell M.P.
      • Sorvillo F.
      • Kuo T.
      The changing trends and profile of pneumocystosis mortality in the United States, 1999–2014.
      ]. Guidelines about PJP prophylaxis in immunocompromised (IC) HIV-negative patients are scarce. CD4+ cell count is less helpful in IC patients than in HIV-positive, and B cells may help clearing Pneumocystis infection [
      • Lund F.E.
      • Hollifield M.
      • Schuer K.
      • Lines J.L.
      • Randall T.D.
      • Garvy B.A.
      B cells are required for generation of protective effector and memory CD4 cells in response to Pneumocystis lung infection.
      ]. Rituximab is a chimeric monoclonal antibody that targets human cell-surface glycoprotein CD20 expressed on B cells. It has gained many indications, especially off-label, for the treatment of autoimmune diseases. Serious infection rates ranging from 2% to 22% have been reported in such uses. The largest cohort of rituximab-related PJP in HIV-negative patients included 30 patients, with 90% of them suffered from blood cancer [
      • Martin-Garrido I.
      • Carmona E.M.
      • Specks U.
      • Limper A.H.
      Pneumocystis pneumonia in patients treated with rituximab.
      ].

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