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Topics:
Internal Medicine • Rheumatology • Interstitial lung disease • Infectious Disease • Pneumocystis pneumonia • Pulmonology • ILD • Diffuse Parenchymal Lung Disease
How do you approach PJP prophylaxis in patients with rheumatic disease on corticosteroids?
Does the presence of ILD change your approach?
Answer from: at Academic Institution
The guidelines for the need for PJP prophylaxis are generally based on the dose of corticosteroids alone (>20 mg prednisolone or equivalent qd for >4 weeks) or steroids in combination with other agents such as azathioprine, cyclophosphamide, or methotrexate. The presence of underlying ILD...
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Answer from: at Community Practice
@Walter W. Chatham: Thanks so much for the Tang article. This is my first time seeing it. Question for you: Why do you choose an absolute lymphocyte count (ALC) less than 400? In Figure 3 of the article, only 2-3 of the patients appear to have an ALC of 200 or higher. If so, I just wonder if a level...
Comments
at University of Nevada - Las Vegas
Re: Tang paper - would note that in Fig 3A, virtua...
Re: Tang paper - would note that in Fig 3A, virtua...
at Gundersen Health System
Please help me understand if I'm misinterpreting, ...
Please help me understand if I'm misinterpreting, ...
at University of Nevada - Las Vegas
If PJP causes lymphopenia, that may be another imp...
If PJP causes lymphopenia, that may be another imp...
Answer from: at Community Practice
I tend to look at the total lymphocyte count - if it is <400/mm³ or embarking on an immunosuppression regimen very likely to effect that (which the guidelines alluded to by Dr. @Smulian are somewhat predictive of) I will initiate PJP prophylaxis. See: Tang et al., PMID 33912176