CTICasesPneumocystis jirovecii Pneumonia (PCP) in a Rheumatoid Arthritis Patient on Adalimumab
Imaging findings
CT in a rheumatoid arthritis patient on adalimumab (Humira) demonstrates diffuse bilateral ground-glass opacity in a crazy-paving pattern with small pleural effusions. Follow-up CT after treatment shows developing basilar fibrosis with traction bronchiectasis and a honeycombing-like pattern.
Key takeaways
TNF-alpha inhibitors such as adalimumab (Humira) are associated with opportunistic infections including Pneumocystis jirovecii pneumonia (PCP), which classically presents with diffuse bilateral ground-glass opacity in a crazy-paving pattern. Pleural effusions are atypical for PCP but may be attributable to the underlying rheumatoid arthritis. Post-PCP fibrosis may be indistinguishable from RA-ILD on subsequent imaging.
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