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.
1.张欣, 赵香梅, 杨绮华, 等. 抗Ro52抗体阳性的抗合成酶综合征患者的临床特征分析[J]. 中华内科杂志, 2022, 61(2): 200-204. [Zhang X, Zhao XM, Yang QH, et al. Clinical characteristics of patients with antisynthetase syndrome and positive anti-Ro52 antibody[J]. Chinese Journal of Internal Medicine, 2022, 61(2): 200-204.] DOI: 10.3760/cma.j.cn112138-20210310-00202.
2.Reid AB, Chen SC, Worth LJ. Pneumocystis jirovecii pneumonia in non-HIV-infected patients: new risks anddiagnostic tools[J]. Curr Opin Infect Dis, 2011, 24(6): 534-544. DOI: 10.1097/QCO.0b013e32834cac17.
3.Avino LJ, Naylor SM, Roecker AM. Pneumocystis jirovecii pneumonia in the non-HIV-infected population[J]. Ann Pharmacother, 2016, 50(8): 673-679. DOI: 10.1177/1060028016650107.
4.Li MC, Lee NY, Lee CC, et al. Pneumocystis jiroveci pneumonia in immunocompromised patients:delayed diagnosis and poor outcomes in non-HIV-infected individuals[J]. J Microbiol Immunol Infect, 2014, 47(1): 42-47. DOI: 10.1016/j.jmii.2012.08.024.
5.Limper AH, Knox KS, Sarosi GA, et al, An official American Thoracic Society statement: treatment of fungal infections in adult pulmonary and critical care patients[J]. Am J Respir Crit Care Med, 2011, 183(1): 96-128. DOI: 10.1164/rccm.2008-740ST.
6.潘文森, 肖冉冉, 宫小薇, 等. 非HIV免疫抑制巨细胞病毒肺炎患者合并感染情况分析[J]. 河北医科大学学报, 2019, 40(12): 1377-1379, 1397. [Pan WS, Xiao RR, Gong XW, et al, Analysis of co-infection in non-HIV immunosuppressed patients with cytomegalovirus pneumonia[J]. Journal of Hebei Medical University, 2019, 40(12): 1377-1379, 1397.] DOI: 10.3969/j.issn.1007-3205.2019.12.004.
7.Raju R, Peters BS, Breen RAM. Lung infections in the HIV-infected adult[J]. Curr Opin Pulm Med, 2012, 18(3): 253-258. DOI: 10.1097/MCP.0b013e32835213d3.
8.Kozhevnikova GM, Voznesenskiy SL, Ermak TN, et al. Opportunistic diseases in patients with HIV infection in the intensive care unit[J]. Ter Arkh, 2018, 90(11): 13-17.DOI: 10.26442/terarkh2018901113-17.
9.姜辉, 张秋彬, 朱华栋. 非艾滋病耶氏肺孢子菌肺炎患者合并巨细胞病毒血症的危险因素分析[J]. 中华急诊医学杂志, 2018, 27(9): 1004-1009. [Jiang H, Zhang QB, Zhu HD. Analysis of risk factors of non HIV pneumocystis jirovecii pneumonia patients complicated with cytomegaloviremia[J]. Chinese Journal of Emergency Medicine, 2018, 27(9): 1004-1009.] DOI: 10.3760/cma.j.issn.1671-0282.2018.09.010.
10.Huang L, Xu S, Huang Z, et al. Risk factors associated with Pneumocystis jirovecii pneumonia in non-HIV immunocompromised patients and co-pathogens analysis by metagenomic next-generation sequencing[J]. BMC Pulm Med, 2023, 23(1): 72. DOI: 10.1186/s12890-022-02300-8.
11.Kaplan JE, Benson C, Holmes KK, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America[J]. MMWR Recomm Rep, 2009, 58(RR-4): 1-207. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5804a1.htm.
12.Yu Q, Jia P, Su L, et al. Outcomes and prognostic factors of non-HIV patients with Pneumocystis jirovecii pneumonia and pulmonary CMV co-infection: a retrospective cohort study[J]. BMC Infect Dis, 2017, 17(1): 392. DOI: 10.1186/s12879-017-2492-8.
13.路明, 李昂, 张静. 非人免疫缺陷病毒免疫抑制患者肺孢子菌肺炎合并巨细胞病毒肺炎的临床特征 [J]. 中国老年学杂志, 2020, 40(2): 313-315. [Lu M, Li A, Zhang J. Clinical characteristics of pneumocystis pneumonia with cytomegalovirus pneumonia in non-human immunodeficiency virus immunosuppressed patients[J]. Chinese Journal of Gerontology, 2020, 40(2): 313-315.]DOI: 10.3969/j.issn.1005-9202.2020.02.027.
14.段艳, 徐媛, 杨长青, 等. 复方磺胺甲噁唑联合卡泊芬净治疗耶氏肺孢子菌肺炎疗效与安全性的Meta分析[J]. 中国真菌学杂志, 2023, 18(1): 1-7. [Duan Y, Xu Y, Yang CQ, et al. Meta-analysis of trimethoprim-sulfamethoxazole combined with caspofungin in the treatment of Pneumocys-tis jirovecii pneumonia[J]. Chinese Journal of Mycology 2023, 18(1): 1-7.] DOI: 10.3969/j.issn.1673-3827.2023.01.001.
15.Zhao J, Hu L, Zhang L,et al. Causative drugs for drug-induced cutaneous reactions in central China: a 608-case analysis[J]. An Bras Dermatol, 2019, 94(6): 664-670. DOI: 10.1016/j.abd.2019.01.007.
16.Brackett CC, Singh H, Block JH. Likelihood and mechanisms of cross-allergenicity between sulfonamide antibiotics and other drugs containing a sulfonamide functional group[J]. Pharmacotherapy, 2004, 24(7): 856-870. DOI: 10.1592/phco.24.9.856.36106.
17.Wulf NR, Matuszewski KA. Sulfonamide cross-reactivity: is there evidence to support broad cross-allergenicity?[J]. Am J Health Syst Pharm, 2013, 70(17): 1483-1494. DOI: 10.2146/ajhp120291.
18.Khan DA, Banerji A, Blumenthal KG, et al. Drug allergy: a 2022 practice parameter update[J]. J Allergy Clin Immunol, 2022, 150(6): 1333-1393. DOI: 10.1016/j.jaci.2022.08.028.
19.Pryor JB, Olyaei AJ, Kirsch D, et al. Sulfonamide desensitization in solid organ transplant recipients: a protocol-driven approach during the index transplant hospitalization[J]. Transpl Infect Dis, 2019, 21(6): e13191. DOI: 10.1111/tid.13191.
20.Negishi S, Miyao K, Ohara F, et al. Feasibility of trimethoprim/sulfamethoxazole desensitization therapy in hematological diseases[J]. Clin Exp Med, 2023, 23(4): 1285-1291. DOI: 10.1007/s10238-022-00868-3.
21.Broyles AD, Banerji A, Barmettler S, et al. Practical Guidance for the evaluation and management of drug hypersensitivity: specific drugs[J]. J Allergy Clin Immunol Pract, 2020, 8(9S): S16-S116. DOI: 10.1016/j.jaip.2020.08.006.
22.原国家卫生计生委办公厅, 国家中医药管理局办公室, 原解放军总后勤部卫生部药品器材局. 抗菌药物临床应用指导原则[S]. 2015: 1-7. https://d.wanfangdata.com.cn/conference/ChZDb25mZXJlbmNlTmV3UzIwMjQwMTA5Egc5NDQ1NjM1Ggh6bGl2dTUxZQ%3D%3D.
23.Caulder CR, Kocherla CS, Qureshi ZP, et al. Dose-dependent hyperkalemia among hospitalized, HIV-infected patients receiving sulfamethoxazole/trimethoprim[J]. Ann Pharmacother, 2020, 54(9): 852-857. DOI: 10.1177/1060028020909539.
24.Sohani ZN, Butler-Laporte G, Aw A, et al. Low-dose trimethoprim-sulfamethoxazole for the treatment of Pneumocystis jirovecii pneumonia (LOW-TMP): protocol for a phase Ⅲ randomised, placebo-controlled, dose-comparison trial[J]. BMJ Open, 2022, 12(7): e053039. DOI: 10.1136/bmjopen-2021-053039.
25.Chang HM, Tsai HC, Lee SSJ, et al. High daily doses of trimethoprim/sulfamethoxazole are an independent risk factor for adverse reactions in patients with pneumocystis pneumonia and AIDS[J]. J Chin Med Assoc, 2016, 79(6): 314-319. DOI: 10.1016/j.jcma.2016.01.007.
26.Sharma B, Antoine M, Shah M, et al. Idiosyncratic drug-induced liver injury secondary to trimethoprim-sulfamethoxazole[J]. Am J Ther, 2020, 27(6): e664-e667.DOI: 10.1097/MJT.0000000000001032.
27.Kwo PY, Cohen SM, Lim JK. ACG Clinical Guideline: evaluation of abnormal liver chemistries[J]. Am J Gastroenterol, 2017, 112(1): 18-35. DOI: 10.1038/ajg.2016.517.
28.中国医药生物技术协会药物性肝损伤防治技术专业委员会, 中华医学会肝病学分会药物性肝病学组. 中国药物性肝损伤诊治指南(2023年版)[J]. 中华肝脏病杂志, 2023, 31(4): 355-384. DOI: 10.3760/cma.j.cn501113-20230419-00176-1.
29.甘草酸制剂肝病临床应用专家委员会. 甘草酸制剂肝病临床应用专家共识[J]. 临床肝胆病杂志, 2016, 32(5): 844-852. DOI: 10.3969/j.issn.1001-5256.2016.05.004.
30.林志强, 陈婷婷. 复方磺胺甲噁唑脱敏治疗1例[J].中国感染与化疗杂志, 2023, 23(3): 371-375. [Lin ZQ, Chen TT. Desensitization to trimethoprim-sulfamethoxazole:a case report[J]. Chinese Journal of Infection and Chemotherapy, 2023, 23(3): 371-375.] DOI: 10.16718/j.1009-7708.2023.03.015.