Severe pneumonia caused by combined infection with Pneumocystis jiroveci, parainfluenza virus type 3, cytomegalovirus, and Aspergillus fumigatus in a patient with Stevens-Johnson syndrome/toxic epidermal necrolysis.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse cutaneous reactions to drugs. We report here the first case of severe pneumonia caused by an unusual combined infection with Pneumocystis carinii (jiroveci), parainfluenza virus type 3, cytomegalovirus and Aspergillus fumigatus in a 63-year-old female patient with allopurinol-induced SJS/TEN overlap syndrome. Following treatment with high-dose systemic corticosteroids and intravenous immunoglobulin for SJS/TEN, her mucocutaneous lesions improved and she was due to be discharged. However, 15 days after cessation of corticosteroids, she developed pneumonia. Broncho-alveolar lavage revealed that the cause of infection was Pneumocystis carinii (jiroveci), parainfluenza virus type 3, cytomegalovirus and Aspergillus. These findings indicate that patients with SJS/TEN, particularly those treated with systemic corticosteroids, may be susceptible to infection with combinations of pathological agents resulting from damage to the bronchial epithelia.
Department Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Taehoon
T
Lee
Yun-Jeong
YJ
Bae
Soo-Kyung
SK
Park
Hyun Jung
HJ
Park
Sung-Han
SH
Kim
You Sook
YS
Cho
Hee-Bom
HB
Moon
Sang-Oh
SO
Lee
Tae-Bum
TB
Kim
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000493:Allopurinol / Q000009:adverse effects; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001232:Aspergillus fumigatus / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000150:complications*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000382:microbiology / Q000628:therapy / Q000821:virology; D008875:Middle Aged; D010224:Parainfluenza Virus 3, Human / Q000472:pathogenicity*; D045363:Pneumocystis carinii / Q000472:pathogenicity*; D011020:Pneumonia, Pneumocystis / Q000382:microbiology*; D055732:Pulmonary Aspergillosis / Q000382:microbiology*; D011859:Radiography; D012121:Respiration, Artificial; D010253:Respirovirus Infections / Q000821:virology*; D012720:Severity of Illness Index; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced / Q000150:complications* / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D016756:Immunoglobulins, Intravenous; D000493:Allopurinol