University of Colorado Anschutz Medical Campus Denver, CO
Paige E. Hammis, MD1, Hadley Greenwood, MD1, Anthony Robateau Colón, MD1, Mark Gerich, MD, MBA1, Waseem Ahmed, MD2 1University of Colorado Anschutz Medical Campus, Denver, CO; 2University of Colorado Anschutz Medical Campus, Los Angeles, CA Introduction: JAK inhibitors (JAKi) are increasingly used for management of inflammatory bowel disease (IBD); however, they can be associated with an increased risk of serious infection. Previous data suggests a low risk of Pneumocystis jirovecii pneumonia (PJP) in IBD patients on advanced therapies, however this risk with use of JAKi is unknown. We describe a patient with Crohn’s disease (CD) diagnosed with PJP after being started on Upadacitinib (UPA).
Case Description/
Methods: A 58-year-old male with history of ileocolonic CD with complex perianal fistulizing disease on 3 months of induction UPA was admitted for acute hypoxic respiratory failure. He previously had an inadequate response to infliximab, ustekinumab and adalimumab.
Evaluation showed bilateral ground glass opacities and positive serum Beta-D-glucan. A diagnosis of PJP was made. He was started on Bactrim with symptomatic response and discharged. His UPA was discontinued and he was transitioned to golimumab with continued PJP prophylaxis. Discussion: Prior studies have shown that the risk of PJP in IBD is low. One study noted only 3 cases of PJP in a cohort of 937 patients with IBD. This was despite the uncommon use of prophylaxis and suggests that the risk of PJP in this population is rare and prophylaxis is not warranted on a routine basis1. Risk factors associated with PJP use in patients with IBD include older age, steroid use, lymphopenia, and other comorbidities.2
Prior case reports have detailed episodes of PJP while on JAKi, both in the rheumatologic and IBD populations. A case by Chin et al. details a patient with UC and primary sclerosing cholangitis who developed PJP three months after starting UPA. 3
Our case highlights the importance of considering PJP risk in patients with IBD on JAKi, particularly in elderly patients on concomitant immunosuppressants with other comorbidities. Further research is needed to determine the risk of PJP in patients with IBD on JAKi, as well as when prophylaxis is warranted.
1. Cotter T et al. Low Risk of Pneumonia From Pneumocystis jirovecii Infection in Patients With Inflammatory Bowel Disease Receiving Immune Suppression. Epub 2016 Dec 21. 850-856.
2. Okafor P et al. Pneumocystis jiroveci pneumonia in inflammatory bowel disease: when should prophylaxis be considered? 2013 Jul. 1764-1771.
3. Chin S et al. Pneumocystis jirovecii Pneumonia Complicating Use of Upadacitinib in a Patient With Ulcerative Colitis and Primary Sclerosing Cholangitis: A Case Report. Epub 2024 Apr 24.
Disclosures: Paige Hammis indicated no relevant financial relationships. Hadley Greenwood indicated no relevant financial relationships. Anthony Robateau Colón indicated no relevant financial relationships. Mark Gerich indicated no relevant financial relationships. Waseem Ahmed: Johnson & Johnson – Advisory Committee/Board Member. Takeda Pharmaceuticals – Consultant.
Paige E. Hammis, MD1, Hadley Greenwood, MD1, Anthony Robateau Colón, MD1, Mark Gerich, MD, MBA1, Waseem Ahmed, MD2. P5543 - The Cost of Control: A Case of Pneumocystis Pneumonia While on Upadacitinib for Crohn’s Disease, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
