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dc.contributor.authorBesada, Emilio
dc.contributor.authorNossent, Johannes C
dc.date.accessioned2014-03-24T10:18:50Z
dc.date.available2014-03-24T10:18:50Z
dc.date.issued2013
dc.description.abstractReports in haematology, transplantation medicine and rheumatology indicate that Rituximab, a B cell depleting therapy, increases the risk for Pneumocystis jiroveci pneumopathy. Patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis have an increased incidence of P. jiroveci pneumopathy compared to other autoimmune diseases and Rituximab is often used to induce and maintain remission. Herein, we present a case of a patient with granulomatosis with polyangiitis treated with Rituximab for relapse that developed P. jiroveci pneumopathy 3 months after and we review the relevant literature to assess P. jiroveci pneumopathy incidence and risks factors under Rituximab. We also discuss whether P. jiroveci screening before Rituximab and P. jiroveci pneumopathy prophylaxis under Rituximab are indicated. P. jiroveci colonisation is found in 25 % of patients with autoimmune diseases. However, the association between colonisation and P. jiroveci pneumopathy development is not very strong. P. jiroveci pneumopathy incidence in ANCA-associated vasculitis patients treated with Rituximab is found to be 1.2 %. Therefore, evidence and practice do not support the use of P. jiroveci pneumopathy chemoprophylaxis in all ANCA-associated vasculitis patients receiving Rituximab. CD4 cell count cut-off does not work well in patients treated with Rituximab as it does not reflect T cell impairment following B cell depletion. To help stratify the risk of both colonisation and P. jiroveci pneumopathy development, assessment of the patient’s net state of immunodeficiency before administering Rituximab—including age, renal or lung involvement, previous infections due to T cell dysfunction, blood tests (lymphocytopenia, low CD4 cell count) and concomitant therapy—is warranted.en
dc.identifier.citationClinical Rheumatology (2013), vol. 32(11):1677-1681en
dc.identifier.cristinIDFRIDAID 1033891
dc.identifier.doihttp://dx.doi.org/10.1007/s10067-013-2293-4
dc.identifier.issn0770-3198
dc.identifier.urihttps://hdl.handle.net/10037/6087
dc.identifier.urnURN:NBN:no-uit_munin_5758
dc.language.isoengen
dc.publisherSpringer Verlagen
dc.rights.accessRightsopenAccess
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Rheumatology: 759en
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Reumatologi: 759en
dc.titleShould Pneumocystis jiroveci prophylaxis be recommended with Rituximab treatment in ANCA-associated vasculitis?en
dc.typeJournal articleen
dc.typeTidsskriftartikkelen
dc.typePeer revieweden


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