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Opportunistic Pulmonary Infection in Patients With Connective Tissue Disease: A Single-Center Experience FREE TO VIEW

Han-Chen Tsai, MSN; Ming-Ji Tsai, MD; Fang-Chi Lin, PhD; Shi-Chuan Chang, PhD
Chest. 2011;140(4_MeetingAbstracts):756A. doi:10.1378/chest.1117845
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PURPOSE: The aim of this study was to describe clinical features and prognosis of opportunistic pulmonary infections in patients with connective tissue disease (CTD) in a single medical center in Taiwan.

METHODS: From March to January 2011, a total of 1361 patients with diffuse pulmonary diseases were subjected to diagnostic bronchoalveolar lavage (BAL) at our hospital. The patients of CTD complicated with opportunistic pulmonary infection were selected and studied.

RESULTS: A total of 11 patients with 12 events of opportunistic pulmonary infections were reviewed, including systemic lupus erythematosus (SLE, n = 7), microscopic polyangiitis (n = 1), progressive systemic sclerosis (PSS, n = 1, rheumatoid arthritis (RA, n = 1), Sjogren syndrome (SS, n = 1). One PSS patient experienced tow episodes of opportunistic pulmonary infections. The most common symptoms included fever, progressive dyspnea, and dry cough. All patients had received empiric antibiotics before BAL. Interstitial lung disease (ILD) was demonstrated by imaging studies. Opportunistic pulmonary infections were diagnosed by examination of BAL fluid (BALF). Pneumocystis jiroveci pneumonia (PCP) was diagnosed in 10 of 12 patients. Mixed infection was found in 5 of 12 events. Six of 12 events died of infection.

CONCLUSIONS: Our results indicated that opportunistic pulmonary infections were uncommon in CTD patients. The most common pathogen was Pneumocystis jiroveci. Mixed infections were not uncommon in CTD with opportunistic pulmonary infections. The mortality of opportunistic pulmonary infection was high in patients with CTD.

CLINICAL IMPLICATIONS: Opportunistic pulmonary infection is uncommon in patients with CTD. Pneumocystis jiroveci appears to be the most common pathogen, and mixed infections were not uncommon in CTD patients with opportunistic pulmonary infection. High index of suspicion and early BAL may be required for early diagnosis and treatment, and for decreasing the mortality.

DISCLOSURE: The following authors have nothing to disclose: Han-Chen Tsai, Ming-Ji Tsai, Fang-Chi Lin, Shi-Chuan Chang

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