A patient with an autoimmune disease who is receiving long-term corticosteroid therapy may be at increased risk for Pneumocystis jirovecii pneumonia. A patient at high risk may benefit from prophylaxis to prevent pneumonia.
Patient selection: autoimmune disease treated with long-term corticosteroids
Risk factors for pneumocystis pneumonia:
(1) daily prednisone dose >= 20 mg for >= 4 weeks (threshold varies with study)
(2) concomitant immunosuppressive drug, especially cyclophosphamide and rituximab
(3) older age (> 50 years)
(4) malnutrition
(5) absolute lymphopenia (< 600 per microliter)
The presence of HIV would further increase the risk.
Most common autoimmune diseases affected:
(1) granulomatosis with polyangiitis (Wegener's)
(2) inflammatory myopathy
(3) SLE
(4) vasculitis
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