Fig. 3

A refractory and recurrent young lupus patient complicated with severe enteritis, thrombocytopenia, and nephropathy admitted to our department. After received high dose glucocorticoid (2 mg/kg) and cyclophosphamide (total dose 1 gram) therapy, she presented fever, dry cough, and mild exertional dyspnea. Subsequent chest HRCT examination revealed new diffuse ground-glass opacity and reticular abnormality (Panel A and B). Simultaneous bedside lung ultrasound showed multiple B-lines, blurred pleural line, and no pleural effusion (Panel C). Pneumocystis jirovecii pneumonia (PJP) was confirmed by bronchoalveolar lavage fluid smear. Trimethoprim-sulfamethoxazole (2 tablets, three time per day) was added while glucocorticoid was reduced (1 mg/kg) and cyclophosphamide was discontinued. In order to avoid radiological exposure, lung ultrasound was used to closely follow up the PJP infection. Ultrasound was performed every two weeks for the first two months, and subsequently performed monthly for follow-up. B-lines elimination and normal pleural line indicated that PJP infection was controlled (Panel D-F), further confirmed by chest HRCT findings (Panel G and H) and improved clinical symptom