Lichen planus (LP) is a chronic mucocutaneous disorder of the stratified squamous epithelium that affects oral and genital mucous membranes, skin, nails, and scalp (1). LP is as a cutaneous and mucosal eruption is usual in middle-aged patients with 30-60 years of age and is more common in females, which rarely reveal with only oral or nail findings (2).
The primary aims of LP treatment are the reduction of painful symptoms, oral mucosal lesions, the risk of oral cancer, and the maintenance of appropriate oral hygiene (3). Up to now, diverse therapies are described for LP including drug therapy, surgery, psoralen with ultraviolet light A (PUVA), and laser (4). Different drugs have been used in the form of topical and intravenous for the LP treatment (5, 6). Systemic corticosteroids and steroid-sparing agents can be used to treat dermatologic conditions like LP(7). Although these immunomodulatory medications have the possibility to decrease morbidity and mortality; its use accompanied with some risk (8). Immunosuppression effect of steroids may predispose patients to infection with opportunistic microorganisms (9), such as Pneumocystis jiroveci (previously P carinii), which can cause potentially life-threatening pneumonia (10). Thus prophylactic agents must be considered as a crucial part of treatment for LP. In this study, we reported a case with 4 years’ steroid treatment period who was involved with pneumocystis pneumonia.
A 48-year-old woman was admitted in our outpatients’ facility with a 3-week history of fever, chill, dyspnea and productive cough. She was treated as community-acquired pneumonia(CAP) with different antibiotics like Azithromycin and Levofloxacin but she had no improvement. Past medical history includes Lichen planus. Patient medications include prednisone 15 mg daily and mycophenolate mofetil(MMF) 1000 mg daily (with a history of 4 years consumption) for LP. She was reported as having no known drug allergies, vomiting, dysuria and sneezing symptom or contact with an infectious source.
Lichen planus; Pneumocystis pneumonia; Antibiotics; HIV