Friendly fire

Pneumocystis jirovecii pneumonia (PJP) is a rare but feared complication in immunocompromised patients. Most experience with PJP stems from patients with the human immunodeficiency infection (HIV) although nephrologists see the occasional case, usually in renal transplant patients during the first post-transplant year. The diagnosis requires a high degree of suspicion and treatment is with highdose trimethoprim–sulfamethoxazole (TMP–SMX), which is usually safe and effective. We recently encountered severe life-threatening side effects in two renal patients treated for proven PJP. We present the cases and provide a brief review of TMP–SMX, with an emphasis on side effects, and its use in renal patients.