<i>Pneumocystis jirovecii</i> Pneumonia Following Initiation of 15 mg Prednisone Daily

A 74-year-old man with chronic obstructive pulmonary disease presented with acute dyspnea and rapidly progressed to hypoxic respiratory failure requiring high levels of noninvasive mechanical ventilation. Three months prior, he was administered prednisone, 15 mg daily for polymyalgia rheumatica. He was subsequently found to have Pneumocystis jirovecii pneumonia, an uncommon infection in the absence of severe immunosuppressive conditions or steroid doses greater than or equal to 20 mg, prednisone daily. The initiation of Pneumocystis jirovecii pneumonia prophylaxis at lower steroid doses is controversial but should be considered in patients with multiple risk factors.