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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1504380
This article is part of the Research Topic New Insights into the Pathogenesis of Idiopathic Inflammatory Myopathy View all 3 articles

Pneumocystis jirovecii pneumonia increases the 3-months mortality of anti-MDA5-antibody-positive dermatomyositis patients

Provisionally accepted
Congcong Gao Congcong Gao 1Gaohui Wei Gaohui Wei 2Chunyi Zhang Chunyi Zhang 1Chenqiong Wang Chenqiong Wang 1Chaoying Li Chaoying Li 1Ruxu Li Ruxu Li 1Zhaohui Su Zhaohui Su 1Zhaohui Zheng Zhaohui Zheng 1*
  • 1 Deparment of Rheumatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
  • 2 Department of Clinical Laboratory, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China

The final, formatted version of the article will be published soon.

    Background: Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis (anti-MDA5+DM) patients are associated with considerable mortality, and opportunistic infections including Pneumocystis jirovecii pneumonia (PJP)is the main cause. This study was to identify clinical characteristics, risk factors, and prognostic factors of PJP diagnosed by bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) in anti-MDA5+ DM patients. Methods: In this retrospective observational study, all patients admitted with suspected pneumonia were detected for mNGS in BALF. The demographics, comorbidities, laboratory parameters, and treatments of the patients were compared and analyzed in both groups to identify the potential risk factors for PJP and death via Logistic regression and Cox proportional hazards regression, respectively.Results: Overall, 92 patients were included in this study, 46(50.0%) were defined as PJP+ group, and the other 46 (50.0%) as PJP-group, and 31(67.4%) PJP occurred in the first 3 months. Increased neutrophil-lymphocyte ratio (NLR) and CRP were independent risk factors for PJP occurrence, while trimethoprim-sulfamethoxazole (TMP/SMZ) prophylaxis was an independent protective factor (all p<0.05). The three-months mortality rate was higher in the PJP+ group compared to PJP-group (64.5% vs 35.5%43.5% vs 23.9%, p=0.047). Rapidly progressive interstitial lung disease (RPILD) was a main predictor of mortality in anti-MDA5+DM patients with PJP, whereas glucocorticoid use was a significant protective factor.Conclusions: PJP has high prevalence and mortality in anti-MDA5+DM, while TMP/SMZ prophylaxis significantly reduces PJP risk. Mortality in PJP+ patients is primarily concentrated within the first 3 months, associated with RPILD. Early intervention with corticosteroids and prophylactic measures are crucial in reducing mortality.

    Keywords: Pneumocystis jirovecii pneumonia, anti-melanoma differentiation-related gene 5, Dermatomyositis, risk factor, Mortality

    Received: 30 Sep 2024; Accepted: 13 Nov 2024.

    Copyright: © 2024 Gao, Wei, Zhang, Wang, Li, Li, Su and Zheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Zhaohui Zheng, Deparment of Rheumatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China

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