High Burden of Coinfection in Systemic Lupus Erythematosus with Bronchoalveolar Lavage Confirmed Pneumocystis jirovecii Pneumonia: A Single-Center Retrospective Study

Abstract Objectives To assess coinfection burden and identify predictors of early mortality in systemic lupus erythematosus (SLE) with bronchoalveolar lavage fluid (BALF)–confirmed Pneumocystis jirovecii pneumonia (PJP). Methods We retrospectively enrolled SLE patients with BALF-confirmed PJP. Clinical and microbiologic data from BALF and blood were reviewed. Predictors of 1-month mortality were analysed using univariable and multivariable logistic regression, with risk stratification and Kaplan–Meier analyses. Results Twenty-four SLE patients with BALF-confirmed PJP were identified. BALF coinfection occurred in 15 (62.5%), most commonly cytomegalovirus (54.2%). Among those assessed, cytomegalovirus viremia was present in 55.0% and bacteremia in 29.2%. The 1-month and in-hospital mortality rates were 37.5% and 62.5%. Twenty patients (83.3%) required intubation. Given the limited number of events, the multivariable model was considered exploratory; concomitant bacteremia (p = .008) and glucocorticoid pulse therapy within 1 month (p = .036) were associated with 1-month mortality. Mortality increased stepwise with 0, 1, and 2 factors (18.8%, 66.7%, and 100%), and Kaplan–Meier analyses showed shorter survival with either factor. Conclusion SLE patients with BALF-confirmed PJP have a high coinfection burden and substantial short-term mortality. Bacteremia and recent glucocorticoid pulse therapy identify a high-risk clinical context. Timely bronchoscopy supports coinfection detection and guides management.