Non-lymphopenic pneumocystis pneumonia in low-dose methotrexate therapy: An exception to every rule

Pneumocystis jiroveci associated pneumonia (PCP) is one of the most important opportunistic conditions affecting immunocompromised patients, especially those with rheumatic diseases, often associated with lymphopenia and high serum LDH levels. The risk of PCP correlates with immunomodulators' dosage given to control patient's underlying disease. We present a case of a PCP involving a non-lymphopenic patient with psoriatic arthritis treated with low dose of methotrexate.