Background: Tacrolimus is an immunosuppressive drug used to prevent acute rejection following organ\r\ntransplantation and to treat autoimmune disease. Tacrolimus is usually prescribed in such situation at a dose of\r\n3.0 mg/day. Pneumocystis pneumonia induced by this dose of tacrolimus has been reported in many cases; however,\r\nwe encountered a rare case of Pneumocystis pneumonia induced by low-dose tacrolimus and methylprednisolone.\r\nCase presentation: We herein report the case of an 82-year-old Asian Japanese female with rheumatoid arthritis and\r\nPneumocystis pneumonia who was being treated with low-dose tacrolimus and low-dose methylprednisolone therapy.\r\nShe was diagnosed with rheumatoid arthritis at 52 years of age and was administered oral low-dose methylprednisolone\r\nand salazosulfapyridine. Her condition had been stable under this treatment for 30 years. However, her arthralgia\r\nworsened three months before admission. The salazosulfapyridine was changed to tacrolimus (0.5 mg/day) by her\r\nphysician, and her arthralgia almost completely disappeared. She was admitted to our hospital for Pseudomonas\r\npneumonia, and her symptoms improved almost completely with intravenous ceftazidime therapy. However, on the\r\n14th day of admission, she developed acute respiratory failure due to Pneumocystis pneumonia and died on the\r\n17th day of admission in spite of adequate treatment.\r\nConclusion: Our report highlights the importance of providing prompt prevention, diagnosis and treatment of\r\nPneumocystis pneumonia in rheumatoid arthritis patients under tacrolimus and low-dose methylprednisolone therapy.
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