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 3 Treatment and clinical outcomes of patients with severe PJP after renal transplantation.
| Treatment regimen | All patients (N = 7) |
|---|---|
| Maintenance glucocorticoid therapy | |
| Methylprednisolone | 3 (42.9%) |
| Prednisone | 4 (57.1%) |
| Maintenance prednisone-equivalent dose | |
| 5 mg/day | 3 (42.9%) |
| 10 mg/day | 4 (57.1%) |
| Duration of TMP-SMX therapy (days) | 22 (10–32) |
| Duration of caspofungin therapy (days) | 15 (10–19) |
| Time from ICU admission to IV corticosteroid initiation (days) | 0 (0–4) |
| IV corticosteroid type | |
| Methylprednisolone | 7 (100%) |
| Initial dose | |
| 40 mg/day | 3 (42.9%) |
| 80 mg/day | 3 (42.9%) |
| 120 mg/day | 1 (14.3%) |
| Duration of methylprednisolone therapy (days) | 11 (5–17) |
| Total methylprednisolone dose (mg) | 580 (200–840) |
| Corticosteroid-related adverse effects | |
| Maximum blood glucose (mmol/L) | 13.9 (10.0–22.1) |
| Insulin therapy required | 4 (57.1%) |
| Maximum serum sodium (mmol/L) | 141 (136–148) |
| Gastrointestinal bleeding | 0 |
| Secondary infection | 0 |
| Duration of mechanical ventilation (days) | 14 (0–25) |
| Length of ICU stay (days) | 18 (11–46) |
| Length of hospital stay (days) | 40 (11–82) |
| Outcome | |
| Recovery | 6 (85.7%) |
| Transfer after clinical improvement | 1 (14.3%) |
| Data are presented as median (range) or n (%). Abbreviations: ICU, intensive care unit; IV, intravenous; PJP, pneumonia; TMP-SMX, trimethoprim-sulfamethoxazole. | |