20 August 2026
: Case report 
Paradoxical Role of Glucocorticoids in Severe Pneumocystis jirovecii Pneumonia Among Renal Transplant Recipients: Case Series
Unusual or unexpected effect of treatment
Xiao-Yun Li ABCDEF 1,2, Wen-Xuan Yu ABCDEF 1,2, Xiang-Ru Chen ABCDEF 1,2, Yao Nie ADEF 1,2, Yong-Jun Liu BCDEF 1,2*DOI: 10.12659/AJCR.952853
Am J Case Rep 2026; 27:e952853
Table 1 Demographic and baseline characteristics of patients with severe PJP after renal transplantation.
| Characteristics | All patients (N = 7) |
|---|---|
| Age (years) | 49 (33–62) |
| Sex | |
| Male | 6 (85.7%) |
| Female | 1 (14.3%) |
| Primary renal diseases | |
| Glomerulonephritis | 4 (57.1%) |
| Hypertensive nephropathy | 2 (28.6%) |
| Diabetic nephropathy | 1 (14.3%) |
| Current comorbidities | |
| Hypertension | 6 (85.7%) |
| Diabetes mellitus | 1 (14.3%) |
| Maintenance immunosuppressive regimen | |
| GC + tacrolimus + mycophenolate sodium | 6 (85.7%) |
| GC + tacrolimus + mycophenolate mofetil | 1 (14.3%) |
| Time from transplantation to onset (years) | 5.0 (0.6–26.0) |
| Symptoms | |
| Fever | 7 (100%) |
| Progressive dyspnea | 5 (71.4%) |
| Dry cough | 3 (42.9%) |
| Diagnosis | |
| Confirmed by BALF mNGS | 6 (85.7%) |
| Confirmed by peripheral blood mNGS | 1 (14.3%) |
| Time from respiratory symptom onset to RF (days) | 6 (2–19) |
| Time from respiratory symptom onset to PJP diagnosis (days) | 10 (3–25) |
| PSI score | 128 (101–152) |
| APACHE II score | 19 (13–30) |
| SOFA score | 8 (3–14) |
| Data are presented as median (range) or n (%). Abbreviations: APACHE II, Acute Physiology and Chronic Health Evaluation II; BALF, bronchoalveolar lavage fluid; GC, glucocorticoid; mNGS, metagenomic next-generation sequencing; PJP, pneumonia; PSI, Pneumonia Severity Index; RF, respiratory failure; SOFA, Sequential Organ Failure Assessment. | |