Community-Acquired Pneumonia with Pseudomonas aeruginosa in a Geriatric Patient with Rheumatoid Arthritis under Baricitinib Treatment.

Abstract

Community-acquired pneumonia (CAP) in older patients presents unique diagnostic challenges. Unlike typical presentations with fever and cough, older adults may experience atypical symptoms like falls, confusion, or chronic disease deterioration. Immunomodulatory treatments for autoimmune diseases further complicate infection risks. This is the first case of a severe Pseudomonas aeruginosa pneumonia in an 86-year-old rheumatoid arthritis patient on baricitinib and prednisone. Initially admitted after a fall, she showed no respiratory symptoms but had a chest x-ray revealing extensive infiltrative consolidation. Sputum analysis confirmed the pneumonia, which was successfully treated with antibiotics. Following the resolution of the infection, the immunomodulatory therapy could be safely reintroduced. The case underscores the critical need for comprehensive diagnostic evaluation in older adults on immunomodulatory therapy, emphasizing that subtle, non-respiratory symptoms can mask serious infections and require heightened clinical suspicion.