Pneumocystis Pneumonia after Initiation of Adalimumab in a Patient with Psoriasis and Concomitant Methotrexate-Induced Pancytopenia

Abstract

Pneumocystis jiroveci pneumonia (PCP) can be a fatal infection developing in those with and without HIV with an increased mortality in those without HIV. The development of biologics for autoimmune and dermatologic disease has increased the prevalence of patients who are immunocompromised due to medication. Our case presents a 51-year-old HIV negative male with psoriasis and psoriatic arthritis who developed PCP after initiating adalimumab. He had previously been taking methotrexate as monotherapy with inadequate control of symptoms. PCP can present with or without respiratory symptoms in those who are immunocompetent, which may cause unintentional shedding to those who are immunocompromised. Due to the detrimental effects of the infection, it is important for dermatologists to be aware of this potential risk of PCP with biologics and considerations for screening for PCP prior to initiating biologic therapy