Paradoxical Role of Glucocorticoids in Severe Pneumocystis jirovecii Pneumonia Among Renal Transplant Recipients: Case Series
Abstract
Case series Patients: — Final Diagnosis: Acute respiratory distress syndrome (ARDS) • Pneumocystis jirovecii pneumonia Symptoms: Dry cough • fever • progressive dyspnea Clinical Procedure: — Specialty: Critical Care Medicine Objective: Unusual or unexpected effect of treatment Background Severe Pneumocystis jirovecii pneumonia (PJP) in renal transplant recipients (RTRs) can rapidly progress to acute respiratory distress syndrome (ARDS) and is associated with high mortality. Glucocorticoids (GCs) play a paradoxical role, constituting a risk factor for infection and a trigger for immune reconstitution inflammatory syndrome upon withdrawal; they may also serve as a therapeutic agent for lung injury. We evaluated the efficacy of a standardized triple-therapy regimen designed to address this paradox. Case Reports We analyzed 7 RTRs admitted to the intensive care unit (ICU) with severe PJP-ARDS between June 2023 and September 2024. The cohort had a median age of 49 years; all patients had prior chronic low-dose GC maintenance therapy without PJP prophylaxis. All diagnoses were confirmed by metagenomic next-generation sequencing. After the onset of severe PJP-ARDS, all immunosuppressive agents were discontinued; patients were treated with trimethoprim-sulfamethoxazole and caspofungin. Early adjunctive intravenous methylprednisolone was administered to all patients, including 4 who received treatment upon ICU admission. The median starting dose was 80 mg/day (range, 40–120 mg/day),…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Drug repositioning: a brief overview
- Cyclic nucleotide phosphodiesterases in Drosophila melanogaster
- Time-resolved in silico modeling of fine-tuned cAMP signaling in platelets: feedback loops, titrated phosphorylations and pharmacological modulation
- Current View on Green Tea Catechins Formulations, Their Interactions with Selected Drugs, and Prospective Applications for Various Health Conditions
- In silico Structure-based Identification of Novel Acetylcholinesterase Inhibitors Against Alzheimer’s Disease
- Development and In Vitro Evaluation of Controlled Release Viagra® Containing Poloxamer-188 Using Gastroplus™ PBPK Modeling Software for In Vivo Predictions and Pharmacokinetic Assessments
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.