High Burden of Coinfection in Systemic Lupus Erythematosus with Bronchoalveolar Lavage Confirmed Pneumocystis jirovecii Pneumonia: A Single-Center Retrospective Study.

OBJECTIVES

To assess coinfection burden and identify predictors of early mortality in systemic lupus erythematosus (SLE) with bronchoalveolar lavage fluid (BALF)-confirmed Pneumocystis jirovecii pneumonia (PJP).

METHODS

We retrospectively enrolled SLE patients with BALF-confirmed PJP. Clinical and microbiologic data from BALF and blood were reviewed. Predictors of 1-month mortality were analysed using univariable and multivariable logistic regression, with risk stratification and Kaplan-Meier analyses.

RESULTS

Twenty-four SLE patients with BALF-confirmed PJP were identified. BALF coinfection occurred in 15 (62.5%), most commonly cytomegalovirus (54.2%). Among those assessed, cytomegalovirus viremia was present in 55.0% and bacteremia in 29.2%. The 1-month and in-hospital mortality rates were 37.5% and 62.5%. Twenty patients (83.3%) required intubation. Given the limited number of events, the multivariable model was considered exploratory; concomitant bacteremia (p = .008) and glucocorticoid pulse therapy within 1 month (p = .036) were associated with 1-month mortality. Mortality increased stepwise with 0, 1, and 2 factors (18.8%, 66.7%, and 100%), and Kaplan-Meier analyses showed shorter survival with either factor.

CONCLUSION

SLE patients with BALF-confirmed PJP have a high coinfection burden and substantial short-term mortality. Bacteremia and recent glucocorticoid pulse therapy identify a high-risk clinical context. Timely bronchoscopy supports coinfection detection and guides management.