Reactions 1680, p242 - 2 Dec 2017 Various toxicities: 11 case report In a retrospective study, 11 patients (eight men and three women) aged 25 76 years were described, who developed Pneumocystis jiroveci pneumonia (eight patients), Pneumocystis jiroveci pneumonia with acute respiratory distress syndrome (one patient), and sepsis and multiple organ failure secondary to Pneumocystis jiroveci pneumonia (two patients) while receiving immunosuppressive therapy with ciclosporin [cyclosporine], mycophenolate mofetil and prednisolone (three patients), tacrolimus and prednisolone (one patient), ciclosporin, mycophenolate sodium and prednisolone (two patients), and tacrolimus, mycophenolate mofetil and prednisolone (five patients). Additionally, one of these 11 patients (a 25-year-old woman) developed cutaneous reaction during treatment with cotrimoxazole [trimethoprim/ sulfamethoxazole; not all dosages stated, routes and durations of treatments to reaction onsets not stated]. All the patients underwent heart transplantation. Following the heart transplantation, the patients started receiving immunosuppressive therapies with ciclosporin, mycophenolate mofetil and prednisolone (three patients), tacrolimus and prednisolone (one patient), ciclosporin, mycophenolate sodium and prednisolone (two patients), and tacrolimus, mycophenolate mofetil and prednisolone (five patients). Five patients (four men and one woman) also received cotrimoxazole as a prophylactic therapy for Pneumocystis jiroveci pneumonia. However, following the immunosuppresive therapies, the patients developed Pneumocystis jiroveci pneumonia (0.4 16.3 years following the heart transplantation). The patients were treated with cotrimoxazole (3.7 19.2 mg/kg/day) for a duration of 6 34 days. Additionally, four men received anidulafungin with cotrimoxazole, and one man received caspofungin with cotrimoxazole. One of these 11 patients (a 25-year-old female) also developed severe cutaneous reaction following treatment with cotrimoxazole, and was switched to primaquine and clindamycin, which eventually resolved. During the last follow up examination after receiving the treatment, eight patients remained alive, but one man died due to acute respiratory distress syndrome and two women died because of sepsis with multiple organ failure. Author comment: "In solid organ transplant recipients receiving standard immunosuppressive therapy, the incidence of Pneumocystis jiroveci pneumonia (PJP) is 5% 14%. . .A review of immunosuppressive agents indicated that the combination of tacrolimus, mycophenolate, and prednisolone was the most commonly prescribed." Lu Y-M, et al. Combination of Echinocandins and Trimethoprim/Sulfamethoxazole for the Treatment of Pneumocystis jiroveci Pneumonia After Heart Transplantation. Transplantation Proceedings 49: 1893-1898, No. 8, Oct 2017. Available from: URL: http://doi.org/10.1016/j.transproceed.2017.04.020 - Taiwan 803285091 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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