Alternative potentials for the treatment of pneumocystic pneumonia in case of intolerance to trimethoprim/sulfamethoxazole: clinical observation of rare complication of immunosuppressive therapy in Takayasu arteritis

Description of the clinical case. A clinical case of Takayasu arteritis complicated by pneumocystis infection with the development of intolerance to standard treatment regimens using trimethoprim/sulfamethoxazole is presented. A 25-year-old woman diagnosed with Takayasu arteritis was treated with methylprednisolone at a dose of 40 mg/day. Due to insufficient effectiveness of the immunosuppressive therapy and the poor tolerance of disease-modifying anti-rheumatic drugs, the use of infliximab (GEBD - a genetically engineered biologic drug) in combination with a high-dose methylprednisolone 40 mg/day was recommended, but it was complicated by the development of pneumocystis pneumonia. Parenteral intravenous antibacterial therapy with trimethoprim/sulfamethoxazole was started. However, due to the intolerance to the antibiotic, its use was refused. It was replaced by an alternative regimen including clindamycin at a dose of 900 mg/day in combination with hydroxychloroquine at a dose of 600 mg/day for 14 days. As a result, positive dynamics was observed. Conclusion. Thus, during the treatment with GEBD it is important to always remember the risk of developing opportunistic infections. To prevent serious complications, early diagnosis of the disease is urgently needed.

autoimmune diseases, Takayasu arteritis, pneumocystis pneumonia, antibacterial therapy, immunosuppressive treatment