Pneumocystis carinii pneumonia in patients with Diamond-Blackfan anemia receiving high-dose corticosteroids.

The authors describe three infants with Diamond-Blackfan anemia receiving corticosteroids who were diagnosed with Pneumocystis carinii pneumonia. Two patients exhibited intermittent neutropenia as well. Each child had been receiving relatively high doses of corticosteroids for at least 2 months, and two were having prednisone tapered when pneumonia developed. One child responded to trimethoprim/sulfamethoxazole and pentamidine, but the other two patients died. Infants with Diamond-Blackfan anemia receiving prolonged corticosteroid therapy should receive P. carinii pneumonia prophylaxis, such as trimethoprim/sulfamethoxazole, and prophylaxis should continue during corticosteroid tapering.