A Japanese female in her 60's on 5 years' treatment with
prednisolone 5 mg for ulcetarive
colitis developed severe bloody stools and
diarrhea and was admitted. A total
colectomy was performed because leukocytapheresis with intravenous
corticosteroid administration (
prednisolone 70 mg/day) relieved her symptoms partially.
Pneumocystis pneumonia (PCP) prophylaxis was not introduced then. She developed acute
respiratory failure on postoperative day (POD) 8, and was intubated and moved to our intensive care unit. PCP was suspected and
sulfamethoxazole/
trimethoprim (ST) was started with
methylprednisolone 40 mg/day. The
pneumonia initially improved but got worse around POD 27 and pulse
corticosteroid therapy was administered.
Antibiotics were first changed to
pentamidine and finally changed to
clindamycin/
primaquine because of adverse reactions due to both of the medications. She recovered fully and experienced no exacerbation after discontinuation of the secondary prophylaxis. This is the first report of
primaquine administration for PCP in Japan.
Clindamycin/
primaquine are second-line drugs but very important because the first-line medications such as ST and
pentamidine cause adverse reactions and frequently result in discontinuation, as was the case in our present patient. Nowadays immunosuppresive
therapy for malingnancies and
autoimmune diseases has been introduced more frequently than before, PCP has attracted more attention. Therefore
primaquine should be approved for appropriate use without delay in Japan.