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Pharmaceutical care of Pneumocystis jirovecii pneumonia secondary to a case of dermatomyositis with previous sulfonamide allergy

Published on May. 07, 2024Total Views: 516 times Total Downloads: 351 times Download Mobile

Author: XIE Fangqing 1, 2 MA Yuan 3 SHU Yang 4 LIN Shibo 2 CHEN Wei 5 FANG Jie 1

Affiliation: 1. Department of Pharmacy, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China 2. Department of Clinical Pharmacology, Chengdu Second People's Hospital, Chengdu 610021, China 3. Department of Pharmacy, The First People's Hospital of Zhaotong, Zhaotong 657000, Yunnan Province, China 4. Department of Clinical Pharmacy, Xinhua Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai 200092, China 5. Department of Respiratory and Critical Care, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200025, China Correponding author: FANG Jie , Email: fj40517@rjh.com.cn

Keywords: Pneumocytis jirovecii pneumonia Cytomegalovirus infection Sulfonamides Sulfonamides desensitization test Pharmaceutical care

DOI: 10.12173/j.issn.1005-0698.202311029

Reference: XIE Fangqing, MA Yuan, SHU Yang, LIN Shibo, CHEN Wei, FANG Jie.Pharmaceutical care of Pneumocystis jirovecii pneumonia secondary to a case of dermatomyositis with previous sulfonamide allergy[J].Yaowu Liuxingbingxue Zazhi,2024, 33(5):578-584.DOI: 10.12173/j.issn.1005-0698.202311029.[Article in Chinese]

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Abstract

A patient with a history of sulfonamide allergy and dermatomyositis was admitted to the hospital due to secondary infection. After admission, a comprehensive examination confirmed the presence of Pneumocystis jirovecii pneumonia (PJP) along with cytomegalovirus (CMV) and Klebsiella pneumoniae infections. Clinical pharmacists actively participated in the treatment process by referring to relevant clinical guidelines. For patients with Pneumocystis jirovecii infection, compound sulfamethoxazole (TMP-SMX) should be considered as the primary choice, while desensitization treatment is recommended for those with a history of sulfonamide allergy. Prior to treatment, the patient had pre-existing liver insufficiency and was on long-term glucocorticoid therapy, with complex medications. The clinical pharmacists provided individualized pharmaceutical care for this case, assisting clinicians in formulating scientifically and reasonably tailored drug treatment plans. They also offered new insights and references for selecting appropriate drugs considering the patient's previous sulfonamide allergies. After sulfonamide desensitization, the patients were administered a combination of TMP-SMX and carpofungin for anti-PJP treatment, along with ganciclovir for anti-CMV treatment, resulting in favorable therapeutic outcomes.

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