Multiple opportunistic infections after high-dose steroid therapy for giant cell arteritis in a patient previously treated with a purine analog.
We present the case of a 74-y-old HIV-negative female who suffered simultaneously from multiple opportunistic infections and a Klebsiella pneumoniae sepsis during high-dose steroids for giant cell arteritis. The patient was treated with a purine analog due to hairy cell leukaemia 10 y previously. Purine analog therapy can lead to long lasting defects in cell-mediated immunity. In these patients, treatment with steroids should be closely monitored with CD4 counts.
Sendi
Parham
P
Unit of Infectious Diseases, Basel University Medical Clinic Liestal, Switzerland. sendi-pa@magnet.ch
Wolf
Angela
A
Graber
Peter
P
Zimmerli
Werner
W
D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects; D001228:Aspergillosis / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology; D017338:Cladribine / Q000009:adverse effects*; D003587:Cytomegalovirus / Q000302:isolation & purification; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D004941:Esophagitis / Q000139:chemically induced / Q000821:virology; D005260:Female; D013700:Giant Cell Arteritis; D006561:Herpes Simplex / Q000139:chemically induced; D006801:Humans; D007710:Klebsiella Infections / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D007943:Leukemia, Hairy Cell; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000175:diagnosis / Q000382:microbiology; D045363:Pneumocystis carinii / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D000970:Antineoplastic Agents; D017338:Cladribine; D003907:Dexamethasone; D000666:Amphotericin B; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D008775:Methylprednisolone