Pneumocystis pneumonia in a patient with lupusnephritis

Patients with lupus nephritis on immunosuppressive therapy are at an increased risk of opportunistic infections. Pneumocystis pneumonia infection though rare, does occur in such patients and is usually missed on commonly conducted investigations. Hence physicians must suspect it when clinical signs and symptoms do not improve in these patients despite being on treatment. being a diagnosed case of lupus nephritis (renal biopsy proven; immunofluorescence microscopy (IMF) showed full house positivity while serum serology revealing decreased levels of both serum C3 and C4, a strong positive ANA and rheumatoid factor). She had previously received three doses of cyclophosphamide. She was referred to us with the complains of pedal edema, fever and cough. Her examination revealed bilateral lung crepitations. Chest X-ray showed well defined shadows adjacent to the lung hilum with air bronchogram. In her bronchoalveolar lavage, a few pseudohyphae along with a positive test for Pneumocystis jiroveci pneumonia (PCP) was detected. Hence, the patient was treated for PCP pneumonia with sulfamethoxazole and trimethoprim. After completion of the course her condition had improved significantly and she was later on discharged.