Pneumocystis jiroveci and cytomegalovirus infection in a pemphigus patient treated with rituximab: a case report and literature review

Abstract

Abstract Background: Rituximab is gradually considered the first-line treatment for pemphigus patients, which may make patients susceptible to opportunistic infections. Pneumocystis jiroveci and cytomegalovirus (CMV), are opportunistic pathogens that have an important impact of morbidity and mortality in immunosuppressed patients. Case presentation: Herein, we present a rare case of a pemphigus patient with pneumonia who was infected concurrently with Pneumocystis jiroveci and CMV. The patient complained of a fever, severe non-productive cough and dyspnea after receiving two infusion of rituximab and was diagnosed with Pneumocystis jiroveci pneumonia (PJP) and CMV infection. Furthermore, we have made a brief review to summarize the features of pemphigus patients with PJP. Conclusion: To our knowledge, this is the first case report depicting a pemphigus patient who was diagnosed with PJP and concomitant pulmonary CMV infection after receiving rituximab. Although the incidence of Pneumocystis jiroveciinfection is low, it is necessary for clinicians to be awake to the possibility of PJP in pemphigus patients with symptoms of pneumonia.