Acute respiratory failure and diffuse pulmonary infiltrates four weeks after rituximab therapy

We report a 51-year-old woman with known SLE on low dose prednisone, recently started on rituximab, who presents with acute respiratory failure and bilateral air space disease. After an initial treatment with broad spectrum antibiotics for healthcare-associated pneumonia and negative serologic studies, a diagnosis of pneumocystis pneumonia was established using bronchoalveolar lavage. We suggest that rituximab can be an aggravating cause of pneumocystis in patients treated with prednisone.