Fatal Pulmonary Co-infection with Pneumocystis and Cytomegalovirus in a Patient with Acquired Immunodeficiency Syndrome

Abstract

A 33-year-old homosexual Japanese man who admitted to having sex with men presented with a two-week history of dyspnea and fever. Chest imaging showed diffuse pulmonary frosted-glass-like shadows. A blood test revealed positive HIV antibodies with a CD4 cell count of 66/μL. Bronchoalveolar lavage identified pneumocystis. Although the patient exhibited a transient response to anti-pneumocystis treatment and megadose steroid pulse therapy, he eventually died from respiratory failure. An autopsy suggested massive cytomegalovirus and pneumocystis pneumonitis. The pulmonary co-infection with cytomegalovirus may have been worsened by the use of mega-dose steroids, and such therapy should be avoided in patients with a high HIV viral load and low CD4 count.

A Molecular Window into the Biology and Epidemiology of Pneumocystis spp

“…(483)(484)(485), Candida spp. (486), Histoplasma capsulatum (487), Mycobacterium tuberculosis (488)(489)(490)(491), Legionella pneumophila (492)(493)(494)(495), Salmonella enterica serovar Enteritidis (496), cytomegalovirus (497)(498)(499)(500)(501)(502)(503)(504)(505)(506), influenza virus (507-509), herpesvirus 6 (510), Strongyloides stercoralis (511,512), Toxoplasma gondii (513), and Trichomonas vaginalis (514). The majority of these cases occurred in patients with severe immunodeficiency.…”

Differences and similarities of high-resolution computed tomography features between pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients

“…Microbiological confirmation is frequently invasive and difficult to obtain, which delays diagnosis and therapy [13]. Furthermore, the absence of microbiological evidence and negative results of serum antibodies are not reliable evidence to rule out pulmonary infection [14]. Imaging, especially high-resolution computed tomography (HRCT), which is fast, non-invasive, and more specific and sensitive than X-rays in detecting early and small lesions, represents a vital tool for guiding the diagnosis and therapeutic progression in patients with pneumonia [15].…”

Differences and similarities of high-resolution computed tomography features between pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients

“…Microbiological con rmation is frequently invasive and di cult to obtain, which delays diagnosis and therapy [13] . Furthermore, the absence of microbiological evidence and negative results of serum antibodies are not reliable evidence to rule out pulmonary infection [14] . Imaging, especially high-resolution computed tomography (HRCT), which is fast, non-invasive, and more speci c and sensitive than X-rays in detecting early and small lesions, represents a vital tool for guiding the diagnosis and therapeutic progression in patients with pneumonia [15] .…”