Severe Pneumonia Caused by Combined Infection with Pneumocystis carinii , Parainfluenza Virus Type 3 , Cytomegalovirus and Aspergillus fumigatus in a Patient with Stevens - Johnson Syndrome / Toxic Epidermal Necrolysis

© 2010 The Authors. doi: 10.2340/00015555-0977 Journal Compilation © 2010 Acta Dermato-Venereologica. ISSN 0001-5555 Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse cutaneous reactions to drugs. We report here the first case of severe pneumonia caused by an unusual combined infection with Pneumocystis carinii (jiroveci), parainfluenza virus type 3, cytomegalovirus and Aspergillus fumigatus in a 63-year-old female patient with allopurinol-induced SJS/TEN overlap syndrome. Following treatment with high-dose systemic corticosteroids and intravenous immunoglobulin for SJS/TEN, her mucocutaneous lesions improved and she was due to be discharged. However, 15 days after cessation of corticosteroids, she developed pneumonia. Broncho alveolar lavage revealed that the cause of infection was Pneumocystis carinii (jiroveci), parainfluenza virus type 3, cytomegalovirus and Aspergillus. These findings indicate that patients with SJS/TEN, particularly those treated with systemic corticosteroids, may be susceptible to infection with combinations of pathological agents resulting from damage to the bronchial epithelia.