Pneumocystis jirovecii infection in autoimmune inflammatory rheumatic diseases in oxford

Background/Aims Pneumocystis jirovecii pneumonia (PJP) is a rare but frequently fatal fungal infection, which can affect patients with rheumatic diseases treated with immunosuppressants or high doses of corticosteroids. The only guidelines for primary prophylaxis of this infection are for vasculitides treated with cyclophosphamide or rituximab. The aim of this abstract is to raise awareness of this preventable infection and to highlight the urgent need to create a tailored risk assessment algorithm to identify patients at increased risk of this infection. Methods We collected information on patients with autoimmune inflammatory rheumatic diseases (AIIRD) who had final working diagnosis of PJP from January 2021 to July 2022 in Oxford University Hospitals NHS Foundation Trust. Patients were identified through infection, respiratory and rheumatology teams. Electronic notes were reviewed to collate clinical data. Results We identified 11 patients who had definite or probable PJP infection of which 7 were female. Of these, 6 were being treated for large vessel vasculitis (LVV), 3 had rheumatoid arthritis (RA) and 2 patients had connective tissue disease (CTD). Median age was 78 years (range 46-93 years). 10 patients had lymphopenia with lymphocyte count <1x10^9/L (the only patient without lymphopenia had chronic lymphocytic leukaemia (CLL)). Prednisolone was prescribed in combination with disease modifying anti-rheumatic drugs (DMARDs) in 6 patients and monotherapy (high dose) in 3 patients, whilst 2 patients were on DMARDs/biologic only. None of the patients who developed PJP had been given prophylaxis prior to the infection. All patients were treated with cotrimoxazole or atovaquone (in one case) for PJP. Unfortunately, 4 died from PJP infection. All these patients were taking 20-60mg prednisolone. Summary patient characteristics are shown in the table below. Conclusion PJP appears to be more common than is currently recognised. Prescribing PJP prophylaxis is not standard practice for patients with CTD and LVV. Consideration needs to be given to PJP prophylaxis for patients on high dose corticosteroids for a prolonged period, particularly in the presence of other risk factors. Better screening mechanisms are needed to identify those patients who will benefit most from PJP prophylaxis. Disclosure A. Verdiyeva: None. A. Escudero Siosi: None. M. Andersson: None. C. Woodrow: None. S. Dubey: None.