allopurinol and Pneumonia--Pneumocystis

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse cutaneous reactions to drugs. We report here the first case of severe pneumonia caused by an unusual combined infection with Pneumocystis carinii (jiroveci), parainfluenza virus type 3, cytomegalovirus and Aspergillus fumigatus in a 63-year-old female patient with allopurinol-induced SJS/TEN overlap syndrome. Following treatment with high-dose systemic corticosteroids and intravenous immunoglobulin for SJS/TEN, her mucocutaneous lesions improved and she was due to be discharged. However, 15 days after cessation of corticosteroids, she developed pneumonia. Broncho-alveolar lavage revealed that the cause of infection was Pneumocystis carinii (jiroveci), parainfluenza virus type 3, cytomegalovirus and Aspergillus. These findings indicate that patients with SJS/TEN, particularly those treated with systemic corticosteroids, may be susceptible to infection with combinations of pathological agents resulting from damage to the bronchial epithelia.

Topics: Adrenal Cortex Hormones; Allopurinol; Anti-Infective Agents; Aspergillus fumigatus; Cytomegalovirus Infections; Drug Therapy, Combination; Female; Humans; Immunoglobulins, Intravenous; Lung Diseases, Interstitial; Middle Aged; Parainfluenza Virus 3, Human; Pneumocystis carinii; Pneumonia, Pneumocystis; Pulmonary Aspergillosis; Radiography; Respiration, Artificial; Respirovirus Infections; Severity of Illness Index; Stevens-Johnson Syndrome; Treatment Outcome