{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T13:27:28Z","timestamp":1793798848655,"version":"4.6.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess coinfection burden and identify predictors of early mortality in systemic lupus erythematosus (SLE) with bronchoalveolar lavage fluid (BALF)-confirmed Pneumocystis jirovecii pneumonia (PJP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively enrolled SLE patients with BALF-confirmed PJP. Clinical and microbiologic data from BALF and blood were reviewed. Predictors of 1-month mortality were analysed using univariable and multivariable logistic regression, with risk stratification and Kaplan\u2013Meier analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-four SLE patients with BALF-confirmed PJP were identified. BALF coinfection occurred in 15 (62.5%), most commonly cytomegalovirus (54.2%). Among those assessed, cytomegalovirus viremia was present in 55.0% and bacteraemia in 29.2%. The 1-month and in-hospital mortality rates were 37.5 and 62.5%, respectively. Twenty patients (83.3%) required intubation. Given the limited number of events, the multivariable model was considered exploratory; concomitant bacteraemia (P\u2009=\u2009.008) and glucocorticoid (GC) pulse therapy within 1\u00a0month (P\u2009=\u2009.036) were associated with 1-month mortality. Mortality increased stepwise with 0, 1, and 2 factors (18.8, 66.7, and 100%), and Kaplan\u2013Meier analyses showed shorter survival with either factor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SLE patients with BALF-confirmed PJP have a high coinfection burden and substantial short-term mortality. Bacteraemia and recent GC pulse therapy identify a high-risk clinical context. Timely bronchoscopy supports coinfection detection and guides management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/mr\/roag041","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T12:03:12Z","timestamp":1778760192000},"page":"979-987","source":"Crossref","is-referenced-by-count":0,"title":["High burden of coinfection in systemic lupus erythematosus with bronchoalveolar lavage confirmed\n                    <i>Pneumocystis jirovecii<\/i>\n                    pneumonia: A single-centre retrospective study"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2037-6681","authenticated-orcid":false,"given":"Kai-Chun","family":"Wang","sequence":"first","affiliation":[{"name":"Division of Allergy-Immunology-Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital , Kaohsiung ,","place":["Taiwan"]},{"name":"The Doctoral Program of Clinical and Experimental Medicine, College of Medicine, National Sun Yat-sen University , Kaohsiung ,","place":["Taiwan"]},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University , Kaohsiung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0546-8695","authenticated-orcid":false,"given":"Chien-Chih","family":"Lai","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital , Taipei ,","place":["Taiwan"]},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University , Taipei ,","place":["Taiwan"]},{"name":"Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University , Taipei ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Sheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital , Taipei ,","place":["Taiwan"]},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University , Taipei ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5930-4840","authenticated-orcid":false,"given":"Hsien-Tzung","family":"Liao","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital , Taipei ,","place":["Taiwan"]},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University , Taipei ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7822-2613","authenticated-orcid":false,"given":"Ming-Han","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital , Taipei ,","place":["Taiwan"]},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University , Taipei ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"De-Feng","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University , Taipei ,","place":["Taiwan"]},{"name":"Division of Immunology and Rheumatology, Fu Jen Catholic University Hospital , New Taipei City ,","place":["Taiwan"]},{"name":"Faculty of Medicine, School of Medicine, Fu Jen Catholic University , New Taipei City ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4154-4018","authenticated-orcid":false,"given":"Chang-Youh","family":"Tsai","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University , Taipei ,","place":["Taiwan"]},{"name":"Division of Immunology and Rheumatology, Fu Jen Catholic University Hospital , New Taipei City ,","place":["Taiwan"]},{"name":"Faculty of Medicine, School of Medicine, Fu Jen Catholic University , New Taipei City ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3129-6006","authenticated-orcid":false,"given":"Ling-Ying","family":"Lu","sequence":"additional","affiliation":[{"name":"Division of Allergy-Immunology-Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital , Kaohsiung ,","place":["Taiwan"]},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University , Kaohsiung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1232-0613","authenticated-orcid":false,"given":"Sheng-Jie","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Taichung Veterans General Hospital , Taichung City ,","place":["Taiwan"]},{"name":"Institute of Biomedical Sciences, College of Life Sciences, National Chung Hsing University , Taichung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Hong","family":"Tai","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Sciences, National Sun Yat-sen University , Kaohsiung ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Syuan","family":"Sun","sequence":"additional","affiliation":[{"name":"Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital , Taipei ,","place":["Taiwan"]},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University , Taipei ,","place":["Taiwan"]},{"name":"Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University , Taipei ,","place":["Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"2026110407415343000_ref1","doi-asserted-by":"crossref","first-page":"i55","DOI":"10.1093\/rheumatology\/kew427","article-title":"Pathways leading to an immunological disease: systemic lupus erythematosus","volume":"56","author":"Zharkova","year":"2017","journal-title":"Rheumatology (Oxford)"},{"key":"2026110407415343000_ref2","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1002\/acr.20683","article-title":"Systematic review of the epidemiology of systemic lupus erythematosus in the Asia-Pacific region: prevalence, incidence, clinical features, and mortality","volume":"64","author":"Jakes","year":"2012","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026110407415343000_ref3","doi-asserted-by":"crossref","first-page":"e794","DOI":"10.1097\/MD.0000000000000794","article-title":"Long-term survival and death causes of systemic lupus erythematosus in China","volume":"94","author":"Wang","year":"2015","journal-title":"Medicine"},{"key":"2026110407415343000_ref4","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1002\/acr.22173","article-title":"Overall and cause-specific mortality in patients with systemic lupus erythematosus: a meta-analysis of observational studies","volume":"66","author":"Yurkovich","year":"2014","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2026110407415343000_ref5","doi-asserted-by":"crossref","first-page":"2323","DOI":"10.1016\/j.chest.2020.05.558","article-title":"Risk factors and prevention of Pneumocystis jirovecii pneumonia in patients with autoimmune and inflammatory diseases","volume":"158","author":"Ghembaza","year":"2020","journal-title":"Chest"},{"key":"2026110407415343000_ref6","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.jmii.2020.07.001","article-title":"Bronchoalveolar lavage fluid analysis and mortality risk in systemic lupus erythematosus patients with pneumonia and respiratory failure","volume":"54","author":"Lai","year":"2021","journal-title":"J Microbiol Immunol Infect Wei Mian Yu Gan Ran Za Zhi"},{"key":"2026110407415343000_ref7","doi-asserted-by":"crossref","first-page":"3479","DOI":"10.1007\/s10067-020-05080-w","article-title":"Etiologies and outcomes of rheumatology patients with acute respiratory failure requiring intensive care: a single-center medical records review study of 259 patients","volume":"39","author":"Shi","year":"2020","journal-title":"Clin Rheumatol"},{"key":"2026110407415343000_ref8","first-page":"1186","article-title":"Risk factors for Pneumocystis carinii pneumonia in patients with polymyositis\/dermatomyositis or systemic lupus erythematosus","volume":"23","author":"Kadoya","year":"1996","journal-title":"J Rheumatol"},{"key":"2026110407415343000_ref9","first-page":"1191","article-title":"Patients with systemic lupus erythematosus at risk for Pneumocystis carinii pneumonia","volume":"19","author":"Porges","year":"1992","journal-title":"J Rheumatol"},{"key":"2026110407415343000_ref10","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1186\/s12879-020-4826-1","article-title":"Hydroxychloroquine may reduce risk of Pneumocystis pneumonia in lupus patients: a nationwide, population-based case-control study","volume":"20","author":"Yeo","year":"2020","journal-title":"BMC Infect Dis"},{"key":"2026110407415343000_ref11","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/s00296-008-0721-6","article-title":"Risk factors of Pneumocystis jeroveci pneumonia in patients with systemic lupus erythematosus","volume":"29","author":"Lertnawapan","year":"2008","journal-title":"Rheumatol Int"},{"key":"2026110407415343000_ref12","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.semarthrit.2016.09.009","article-title":"Pneumocystis jirovecii pneumonia in systemic autoimmune rheumatic disease: a case\u2013control study","volume":"46","author":"Tadros","year":"2017","journal-title":"Semin Arthritis Rheum"},{"key":"2026110407415343000_ref13","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4065\/71.1.5","article-title":"Pneumocystis carinii pneumonia in patients without acquired immunodeficiency syndrome: associated illness and prior corticosteroid therapy","volume":"71","author":"Yale","year":"1996","journal-title":"Mayo Clin Proc"},{"key":"2026110407415343000_ref14","doi-asserted-by":"crossref","first-page":"e0139144","DOI":"10.1371\/journal.pone.0139144","article-title":"Pneumocystis pneumonia in patients with autoimmune diseases: a retrospective study focused on clinical characteristics and prognostic factors related to death","volume":"10","author":"Chen","year":"2015","journal-title":"PLoS One"},{"key":"2026110407415343000_ref15","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1002\/1529-0131(199904)42:4<780::AID-ANR23>3.0.CO;2-M","article-title":"Pneumocystis carinii pneumonia in patients with connective tissue diseases: the role of hospital experience in diagnosis and mortality","volume":"42","author":"Ward","year":"1999","journal-title":"Arthritis Rheum"},{"key":"2026110407415343000_ref16","doi-asserted-by":"crossref","first-page":"e0214324","DOI":"10.1371\/journal.pone.0214324","article-title":"Prognostic factors of Pneumocystis pneumonia in patients with systemic autoimmune diseases","volume":"14","author":"Kageyama","year":"2019","journal-title":"PLoS One"},{"key":"2026110407415343000_ref17","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1186\/s12879-024-09757-4","article-title":"Prognostic analysis of concurrent Pneumocystis jirovecii pneumonia in patients with systemic lupus erythematosus: a retrospective study","volume":"24","author":"Shi","year":"2024","journal-title":"BMC Infect Dis"},{"key":"2026110407415343000_ref18","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1002\/art.1780400928","article-title":"Updating the American college of rheumatology revised criteria for the classification of systemic lupus erythematosus","volume":"40","author":"Hochberg","year":"1997","journal-title":"Arthritis Rheum"},{"key":"2026110407415343000_ref19","doi-asserted-by":"crossref","first-page":"2677","DOI":"10.1002\/art.34473","article-title":"Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus","volume":"64","author":"Petri","year":"2012","journal-title":"Arthritis Rheum"},{"key":"2026110407415343000_ref20","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/TP.0000000000001927","article-title":"Cytomegalovirus viral load in bronchoalveolar lavage to diagnose lung transplant associated CMV pneumonia","volume":"102","author":"Lodding","year":"2018","journal-title":"Transplantation"},{"key":"2026110407415343000_ref21","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1164\/rccm.201807-1358ED","article-title":"In search of clinical factors that predict risk for Pneumocystis jirovecii pneumonia in patients without HIV\/AIDS","volume":"198","author":"Limper","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"2026110407415343000_ref22","doi-asserted-by":"crossref","first-page":"e001508","DOI":"10.1136\/rmdopen-2020-001508","article-title":"Estimation of treatment and prognostic factors of pneumocystis pneumonia in patients with connective tissue diseases","volume":"7","author":"Ishikawa","year":"2021","journal-title":"RMD Open"},{"key":"2026110407415343000_ref23","doi-asserted-by":"crossref","first-page":"251","DOI":"10.3899\/jrheum.180104","article-title":"Cytomegaloviral or Pneumocystis jirovecii pneumonia increases mortality in systemic lupus erythematosus patients with pulmonary hemorrhage: evidence from bronchoalveolar lavage fluid","volume":"46","author":"Sun","year":"2019","journal-title":"J Rheumatol"},{"key":"2026110407415343000_ref24","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1136\/ard-2023-224762","article-title":"EULAR recommendations for the management of systemic lupus erythematosus: 2023 update","volume":"83","author":"Fanouriakis","year":"2024","journal-title":"Ann Rheum Dis"},{"key":"2026110407415343000_ref25","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/rheumatology\/kex286","article-title":"The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults","volume":"57","author":"Gordon","year":"2017","journal-title":"Rheumatology (Oxford)"},{"key":"2026110407415343000_ref26","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1002\/art.43212","article-title":"2024 American College of Rheumatology (ACR) guideline for the screening, treatment, and management of lupus nephritis","volume":"77","author":"Sammaritano","year":"2025","journal-title":"Arthritis Rheumatol"},{"key":"2026110407415343000_ref27","doi-asserted-by":"crossref","first-page":"429","DOI":"10.3904\/kjim.2016.234","article-title":"Infection in systemic lupus erythematosus, similarities, and differences with lupus flare","volume":"32","author":"Jung","year":"2017","journal-title":"Korean J Intern Med"},{"key":"2026110407415343000_ref28","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1177\/0961203313493032","article-title":"Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies","volume":"22","author":"Danza","year":"2013","journal-title":"Lupus"},{"key":"2026110407415343000_ref29","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1093\/rheumatology\/ker368","article-title":"Lupus disease activity and the risk of subsequent organ damage and mortality in a large lupus cohort","volume":"51","author":"Lopez","year":"2012","journal-title":"Rheumatology (Oxford)"},{"key":"2026110407415343000_ref30","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1002\/art.39070","article-title":"Serious infections among adult medicaid beneficiaries with systemic lupus erythematosus and lupus nephritis","volume":"67","author":"Feldman","year":"2015","journal-title":"Arthritis Rheumatol"},{"key":"2026110407415343000_ref31","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1086\/513988","article-title":"Novel anti-Pneumocystis carinii effects of the immunosuppressant mycophenolate mofetil in contrast to provocative effects of tacrolimus, sirolimus, and dexamethasone","volume":"175","author":"Oz","year":"1997","journal-title":"J Infect Dis"},{"key":"2026110407415343000_ref32","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1590\/S0036-46652005000300005","article-title":"Mycophenolate mofetil may protect against Pneumocystis carinii pneumonia in renal transplanted patients","volume":"47","author":"Azevedo","year":"2005","journal-title":"Rev Inst Med Trop S\u00e3o Paulo"},{"key":"2026110407415343000_ref33","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1177\/0961203317703494","article-title":"Low prevalence of Pneumocystis pneumonia in hospitalized patients with systemic lupus erythematosus: review of a clinical data warehouse","volume":"26","author":"Kapoor","year":"2017","journal-title":"Lupus"},{"key":"2026110407415343000_ref34","first-page":"265","article-title":"Antibiotic allergy in systemic lupus erythematosus: a case-control study","volume":"19","author":"Petri","year":"1992","journal-title":"J Rheumatol"},{"key":"2026110407415343000_ref35","first-page":"47","article-title":"Incidence of Pneumocystis jirovecii pneumonia and prophylaxis-associated adverse events among patients with systemic lupus erythematosus","volume":"52","author":"Jiang","year":"2025","journal-title":"J Rheumatol"},{"key":"2026110407415343000_ref36","doi-asserted-by":"crossref","first-page":"152106","DOI":"10.1016\/j.semarthrit.2022.152106","article-title":"Rates of Pneumocystis jirovecii pneumonia and prophylaxis prescribing patterns in a large electronic health record cohort of patients with systemic lupus erythematosus","volume":"57","author":"Boone","year":"2022","journal-title":"Semin Arthritis Rheum"},{"key":"2026110407415343000_ref37","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s10238-024-01503-z","article-title":"The role of trimethoprim\/sulfamethoxazole in preventing opportunistic infections in systemic lupus erythematosus patients receiving low-level immunosuppressive treatment: an open-label, randomized, controlled trial","volume":"24","author":"Munthananuchat","year":"2024","journal-title":"Clin Exp Med"},{"key":"2026110407415343000_ref38","doi-asserted-by":"publisher","DOI":"10.1002\/acr.25690","article-title":"American College of Rheumatology (ACR) guideline for the treatment of systemic lupus erythematosus","author":"Sammaritano","year":"2025","journal-title":"Arthritis Care Res (Hoboken) Online ahead of print"},{"key":"2026110407415343000_ref39","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1128\/CMR.00013-12","article-title":"Colonization by Pneumocystis jirovecii and its role in disease","volume":"25","author":"Morris","year":"2012","journal-title":"Clin Microbiol Rev"}],"container-title":["Modern Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mr\/advance-article-pdf\/doi\/10.1093\/mr\/roag041\/68293443\/roag041.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mr\/article-pdf\/36\/6\/979\/68293443\/roag041.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mr\/article-pdf\/36\/6\/979\/68293443\/roag041.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T12:42:06Z","timestamp":1793796126000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mr\/article\/36\/6\/979\/8678965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":39,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,5,15]]},"published-print":{"date-parts":[[2026,11,4]]}},"URL":"https:\/\/doi.org\/10.1093\/mr\/roag041","relation":{},"ISSN":["1439-7595","1439-7609"],"issn-type":[{"value":"1439-7595","type":"print"},{"value":"1439-7609","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,5,15]]}}}