Abstract:
:We report the case of a 21-year-old man who was noted to have pneumomediastinum during an admission for an acute flare of ulcerative colitis. At that time, he was on maintenance treatment with azathioprine at a dose of 1.25 mg/kg per day, and had not received supplementary steroids for 9 mo. He had never received anti-tumor necrosis factor (TNF)alpha therapy. Shortly after apparently effective treatment with intravenous steroids and an increased dose of azathioprine, he developed worsening colitic and new respiratory symptoms, and was diagnosed with Pneumocystis jiroveci (carinii) pneumonia (PCP). Pneumomediastinum is rare in immunocompetent hosts, but is a recognized complication of PCP in human immunodeficiency virus (HIV) patients, although our patient's HIV test was negative. Treatment of PCP with co-trimoxazole resulted in resolution of both respiratory and gastrointestinal symptoms, without the need to increase the steroid dose. There is increasing vigilance for opportunistic infections in patients with inflammatory bowel disease following the advent of anti-TNFalpha therapy. This case emphasizes the importance of considering the possibility of such infections in all patients with inflammatory bowel disease, irrespective of the immunosuppressants they receive, and highlights the potential of steroid-responsive opportunistic infections to mimic worsening colitic symptoms in patients with ulcerative colitis.
journal_name
World J Gastroenteroljournal_title
World journal of gastroenterologyauthors
Lee JC,Bell DC,Guinness RM,Ahmad Tdoi
10.3748/wjg.15.1897subject
Has Abstractpub_date
2009-04-21 00:00:00pages
1897-900issue
15eissn
1007-9327issn
2219-2840journal_volume
15pub_type
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journal_title:World journal of gastroenterology
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journal_title:World journal of gastroenterology
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pub_type: 杂志文章,评审
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pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章,meta分析
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,meta分析,评审
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v23.i20.3675
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journal_title:World journal of gastroenterology
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doi:10.3748/wjg.v21.i1.262
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pub_type: 杂志文章
doi:10.3748/wjg.v10.i3.419
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
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journal_title:World journal of gastroenterology
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
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更新日期:2007-03-07 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
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journal_title:World journal of gastroenterology
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更新日期:2011-09-21 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.15.1645
更新日期:2009-04-07 00:00:00