A Rare Case of Pneumocystis Pneumonia in HIV Patient on Glucocorticoid

Abstract

Pneumocystis pneumonia (PCP) is an opportunistic infection caused by Pneumocystis jirovecii. PCP due to immunosuppressive drugs is rarely reported in the literature. Herein we present a case of PCP in a 49-yearold patient who presented with progressive shortness of breath, dry cough, and low-grade fever. History revealed that he was taking prednisolone daily for his hyperactive airway disease. His temperature was 99 o F, and he had bilateral crackles in the lungs with resonant wheezing. High-resolution computed tomography showed diffuse ground-glass haze and cystic lesions in the middle and upper zones of both lungs. He was commenced on intravenous ceftriaxone and methylprednisolone based on provisional diagnosis of interstitial pneumonia. However, his condition worsened. His human immunodeficiency virus (HIV) test was reactive, and his CD4+ count was 275 cells/mm 3 . Bronchoalveolar lavage revealed PCP by direct immunofluorescent assay. Additional serum testing revealed marked elevation of beta-D-glucan, consistent with PCP diagnosis due to glucocorticoid use. Trimethoprim-sulfamethoxazole and voriconazole were initiated, and his respiratory symptoms started improving. His respiratory condition improved on day 9, and he was discharged with follow-up.

Trimethoprim-Sulfamethoxazole (Bactrim) Dose Optimization in Pneumocystis jirovecii Pneumonia (PCP) Management: A Systematic Review

“…Twenty-five articles were excluded due to the following reasons: no full-text ( N = 09), literature reviews ( N = 04), inappropriate intervention ( N = 03), no required data ( N = 03), and non-English ( N = 06). A total of 13 articles met the inclusion criteria for final analysis [ 3 , 8 , 13 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Of the 13 selected studies, nine were retrospective cohort studies [ 8 , 13 , 25 , 26 , 27 , 28 , 29 , 30 , 34 ], two case reports [ 31 ] and two randomized controlled trial (RCT) [ 3 , 33 ].…”

“…A total of 13 articles met the inclusion criteria for final analysis [ 3 , 8 , 13 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Of the 13 selected studies, nine were retrospective cohort studies [ 8 , 13 , 25 , 26 , 27 , 28 , 29 , 30 , 34 ], two case reports [ 31 ] and two randomized controlled trial (RCT) [ 3 , 33 ]. The PRISMA flow diagram reporting the procedure of selection of studies is shown in Figure 1 .…”

Massive Cavitation by Pneumocystis jirovecii in an Immunocompromised Patient

“…Although the radiological aspects described above are typical of pulmonary infection with P. jirovecii , the existence of focal cystic lesions has been reported, with only a few studies showing cavitary lesions during PCP [ 21 , 22 ]. The definitive diagnosis of PCP is made by polymerase chain reaction (PCR) of respiratory specimens or fluorescein antibody staining [ 23 ].…”