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Pneumocystis Pneumonia Following RituximabPneumocystis Pneumonia Following Rituximab FREE TO VIEW

Joshua D. Farkas, MD; Ryan D. Clouser, DO; Garth W. Garrison, MD
Author and Funding Information

From the Department of Pulmonary and Critical Care, University of Vermont College of Medicine.

Correspondence to: Joshua D. Farkas, MD, Department of Pulmonary and Critical Care, University of Vermont College of Medicine, 89 Beaumont Ave, Given Bldg, Room D208, Burlington, VT 05405; e-mail: farkasmd@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):663-664. doi:10.1378/chest.13-2539
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Published online
To the Editor:

We read with interest the article by Martin-Garrido et al1 in a recent issue of CHEST (July 2013) that described a series of 30 cases of Pneumocystis pneumonia at the Mayo Clinic between 1998 and 2011 in association with rituximab. Three cases within this series were associated solely with rituximab (with the remaining 27 cases also associated with steroids, chemotherapy, or both, which are known risk factors). It is noteworthy that in all three cases, the diagnosis was made solely on the basis of polymerase chain reaction (PCR) testing compared with only 12 of the remaining 27 cases. Although this difference is not statistically significant, it raises the question of whether these three cases could have been false-positive diagnoses due to colonization by Pneumocystis.

The performance of the PCR assay used in this study was previously described at the same institution.2 In that publication, 27 immunosuppressed patients were found to have a positive PCR result with normal direct fluorescent microscopy examination findings. Among these, only 84% were considered to have definite or probable Pneumocystis pneumonia. This report found no PCR positivity among 102 immunocompetent patients, suggesting that the rate of Pneumocystis colonization may be higher among immunosuppressed patients.

Given the high volume of complex cases evaluated at the Mayo Clinic, three cases over a 14-year span may represent a very low false-positive rate. Prior to concluding that rituximab alone may predispose to Pneumocystis pneumonia, it would be useful to know the details of these three cases.

References

Martin-Garrido I, Carmona EM, Specks U, Limper AH. Pneumocystispneumonia in patients treated with rituximab. Chest. 2013;144(1):258-265. [CrossRef] [PubMed]
 
Wilson JW, Limper AH, Grys TE, Karre T, Wengenack NL, Binnicker MJ. Pneumocystis jiroveciitesting by real-time polymerase chain reaction and direct examination among immunocompetent and immunosuppressed patient groups and correlation to disease specificity. Diagn Microbiol Infect Dis. 2011;69(2):145-152. [CrossRef] [PubMed]
 

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References

Martin-Garrido I, Carmona EM, Specks U, Limper AH. Pneumocystispneumonia in patients treated with rituximab. Chest. 2013;144(1):258-265. [CrossRef] [PubMed]
 
Wilson JW, Limper AH, Grys TE, Karre T, Wengenack NL, Binnicker MJ. Pneumocystis jiroveciitesting by real-time polymerase chain reaction and direct examination among immunocompetent and immunosuppressed patient groups and correlation to disease specificity. Diagn Microbiol Infect Dis. 2011;69(2):145-152. [CrossRef] [PubMed]
 
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