{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:40:01Z","timestamp":1756284001626,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,4,12]]},"abstract":"<jats:p>We present a case of a 57-year-old woman who contracted <jats:italic>Pneumocystis jiroveci<\/jats:italic> pneumonia while on Benepali, the biosimilar version of etanercept for rheumatoid arthritis. She had seropositive erosive disease. She was admitted to clinic with a 2-week history of dyspnoea, dry cough and fever. Her initial examination showed her to be hypoxic on air with saturations of 77% and left basal crackles. Her admission chest X-ray showed fine reticular shadowing, with an initial suspicion of pulmonary fibrosis. She was empirically treated for community-acquired pneumonia but continued to deteriorate with a worsening type 1 respiratory failure. She was intubated and ventilated on intensive care. The suspicion was raised of <jats:italic>P. jiroveci<\/jats:italic> pneumonia given her immunosuppression, hypoxic presentation and chest X-ray changes. This was confirmed on sputum PCR. She was treated with a 3-week course of steroids and co-trimoxazole. She was discharged home after a 2-week admission.<\/jats:p>","DOI":"10.1136\/bcr-2018-224764","type":"journal-article","created":{"date-parts":[[2018,4,21]],"date-time":"2018-04-21T06:05:15Z","timestamp":1524290715000},"page":"bcr-2018-224764","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["<i>Pneumocystis jiroveci<\/i> pneumonia in a patient taking Benepali for rheumatoid arthritis"],"prefix":"10.1136","volume":"2018","author":[{"given":"Kay Frances","family":"Graham","sequence":"first","affiliation":[{"name":"Rheumatology, Glasgow Royal Infirmary, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"McEntegart","sequence":"additional","affiliation":[{"name":"Rheumatology, Glasgow Royal Infirmary, Glasgow, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,4,21]]},"reference":[{"key":"2025082701110527000_2018.apr21_1.bcr-2018-224764.1","unstructured":"Smolen JS , Landew\u00e9 R , Breedveld FC , et al . EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. \u00a0Ann Rheum Dis 2013;73."},{"key":"2025082701110527000_2018.apr21_1.bcr-2018-224764.2","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-006-9250-x"},{"key":"2025082701110527000_2018.apr21_1.bcr-2018-224764.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/6730812","article-title":"Incidence and risk factors for infections requiring hospitalization, including pneumocystis pneumonia, in Japanese patients with rheumatoid arthritis","volume":"2017","author":"Hashimoto","year":"2017","journal-title":"Int J Rheumatol"},{"key":"2025082701110527000_2018.apr21_1.bcr-2018-224764.4","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1093\/rheumatology\/kex269","article-title":"52-week results of the phase 3 randomized study comparing SB4 with reference etanercept in patients with active rheumatoid arthritis","volume":"56","author":"Emery","year":"2017","journal-title":"Rheumatology"},{"key":"2025082701110527000_2018.apr21_1.bcr-2018-224764.5","doi-asserted-by":"crossref","unstructured":"De Cock D , Watson K , Hyrich KL . Biosimilars in the United Kingdom: first real-world data from the british society for rheumatology biologics registers for rheumatoid arthritis. 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Pneumocystis jirovecii pneumonia in rheumatoid arthritis patients: risks and prophylaxis recommendations. clinical medicine insights: circulatory, respiratory and pulmonary medicine. 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