Rituximab identified as an independent risk factor for severe PJP: A case-control study

by Anat Zalmanovich, Ronen Ben-Ami, Galia Rahav, Danny Alon, Allon Moses, Karen Olshtain-Pops, Miriam Weinberger, Pnina Shitrit, Michal Katzir, Bat-Sheva Gottesman, Michal Chowers

Pneumocystis jirovecii pneumonia (PJP) was reported among immunosuppressed patients with deficits in cell-mediated immunity and in patients treated with immunomodulatory drugs. The aim of this study was to identify risk-factors for PJP in noninfected HIV patients.

This retrospective, test negative, case-control study was conducted in six hospitals in Israel, 2006–2016. Cases were hospitalized HIV-negative patients with pneumonia diagnosed as PJP by bronchoalveolar lavage. Controls were similar patients negative for PJP.

Seventy-six cases and 159 controls were identified. Median age was 63.7 years, 65% males, 34% had hematological malignancies, 11% inflammatory diseases, 47% used steroids and 9% received antilymphocyte monoclonal antibodies. PJP was independently associated with antilymphocyte monoclonal antibodies (OR 11.47, CI 1.50–87.74), high-dose steroid treatment (OR 4.39, CI 1.52–12.63), lymphopenia (OR 8.13, CI 2.48–26.60), low albumin (OR 0.15, CI 0.40–0.54) and low BMI (OR 0.80, CI 0.68–0.93).

In conclusion, rituximab, which is prescribed for a wide variety of malignant and inflammatory disorders, was found to be significant risk-factor for PJP. Increased awareness of possible PJP infection in this patient population is warranted.