Background:

Pneumocystis cariniipneumonia (PCP) occurs in immunocompromised patients without the acquired immunodeficiency syndrome (AIDS). There has been an increasing yearly number of cases of PCP in our patients without AIDS.

Objective:

To determine the nature of the underlying disorder and previous immunosuppressive treatment in patients with PCP without AIDS.

Method:

A study of the charts of 78 such patients admitted to our hospital from 1980 through 1993.

Results:

The number of PCP cases per year increased during the period studied. All patients had an underlying disorder, either hematologic malignancy (49%), solid organ tumor (4%), vasculitis or other immunologic disorder (22%), or they had undergone renal transplantation (17%) or bone marrow transplantation (9%). Previous immunosuppressive medication consisted of prednisone or other corticosteroids in 72 (92%) of 78 patients, cytotoxic drugs in 55 (71%) of 78 patients, both in 50 (64%) of 78 patients, and none in one patient. Quantification of previous corticosteroid treatment showed a large variability among patients. The overall mortality rate for patients was 35% (27/78). Mortality was significantly higher in patients with a concomitant pulmonary infection (P=.01), an underlying disorder other than that which resulted in renal transplantation (P=.03), mechanical ventilation (P<.001), previous chemotherapy (P=.04), as well as previous cyclophosphamide treatment (P=.01). A trend toward a higher mortality in patients with previous corticosteroid use was detected (P=.06).

Conclusion:

Pneumocystis cariniipneumonia may complicate a variety of immunocompromised states, with considerable mortality.Pneumocystis cariniipneumonia occurred at all levels of immunosuppression; no threshold level could be defined. (Arch Intern Med. 1995;155:2436-2441)

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