SynthesisBMC infectious diseases2026
Non-HIV Pneumocystis jirovecii pneumonia-associated immune reconstitution inflammatory syndrome: a case report and systematic review.
Synthesis in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPneumocystis jirovecii pneumonia (PJP) is a common opportunistic infection with high mortality among immunocompromised patients. Although adjunctive glucocorticoid therapy improves outcomes in HIV-associated PJP, its role in non-HIV patients remains controversial. Immune reconstitution inflammatory syndrome (IRIS), a potentially overlooked inflammatory response, may lead to rapid clinical deterioration. CASE PRESENTATION: A 60-year-old woman developed non-HIV-associated PJP following high-dose glucocorticoid therapy for anti-IgLON5 antibody-associated encephalopathy, which progressed to severe hypoxic respiratory failure. During anti-PJP treatment, glucocorticoids were rapidly tapered and discontinued because of concerns regarding immunosuppression. Subsequently, the patient developed recurrent fever, worsening oxygenation, and radiographic progression, while IL-6 levels increased from 5.3 pg/mL to 574 pg/mL. Microbiological testing revealed no evidence of new infection. Considering the recent immune reconstitution, PJP-associated IRIS was diagnosed. After glucocorticoid therapy was reinitiated while the original anti-PJP regimen was maintained, inflammatory markers decreased significantly, respiratory function improved, and mechanical ventilation was successfully discontinued. Additionally, we reviewed previously reported cases of non-HIV-associated PJP-IRIS. Combined with the present case, eight patients were included. Most cases had a clear immune reconstitution trigger and presented with progressive hypoxemia, radiographic deterioration, and inflammatory activation. Most patients improved after intensive glucocorticoid therapy.
conclusionIn non-HIV-associated PJP, clinical deterioration does not necessarily indicate antimicrobial treatment failure, and PJP-associated IRIS should be considered. Early recognition of inflammatory activation and timely immunomodulatory therapy may improve prognosis. Dynamic monitoring of inflammatory markers such as IL-6 may help guide glucocorticoid therapy.
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