[Pneumocystis carinii and cytomegalovirus pneumonia after corticosteroid therapy in acute severe alcoholic hepatitis: 2 case reports].
Most cases of infections described after steroid treatment for severe acute alcoholic hepatitis are of bacterial origin. However, the rate of bacterial infections in these patients is not higher than in those who are not treated by steroids. The opportunistic infections are even more rare. We report two cases of patients with cirrhosis and human immunodeficiency virus, treated for alcoholic hepatitis with steroids and who subsequently developed severe pneumopathy due to Pneumocystis carinii. One patient had a concommitant cytomegalovirus infection and both of them died. Pneumocystis carinii infections usually occur in patients a decreased immune cellular response. Steroid treatments and also alcohol may be responsible for these opportunistic infections. Alcohol may have an immunosuppressive effect by decreasing recruitment of CD4 and CD8 lymphocytes to the lungs. In conclusion, Pneumocystis carinii pneumonia is a potential complication of steroid treatments for acute alcoholic hepatitis and should be suspected in case of unexplained pulmonary infection.
Ichai
Philippe
P
Centre Hépato-Biliaire, Hôpital Paul Brousse, UPRES 1596, Université Paris Sud, Villejuif, France. philippe.ichai@pbr.ap-hop-paris.fr
Azoulay
Daniel
D
Feray
Cyrille
C
Saliba
Faouzi
F
Antoun
Fadi
F
Roche
Bruno
B
Bismuth
Henri
H
Samuel
Didier
D
D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000150:complications; D006519:Hepatitis, Alcoholic / Q000188:drug therapy*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections; D011020:Pneumonia, Pneumocystis / Q000209:etiology*
D000305:Adrenal Cortex Hormones