Pneumocystis pneumonia causing cavitating lung nodules in an immunocompetent individual

Ojuawo, Olutobi; Htwe, Thidar; Thein, Onn Shaun; Sahal, Adeel

doi:10.1136/bcr-2020-241061

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…In literature, PCP is uncommon in immunocompetent subjects. 6 , 7 More rarely, few cases have been reported in immunocompetent without any underlying diseases like our patient.…”

Section: Discussionmentioning

confidence: 63%

Pneumocystis jirovecii pneumonia in a healthy immunocompetent patient: A case report and literature review

Rouis,

Moussa,

Houcine

et al. 2023

SAGE Open Medical Case Reports

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Pneumocystis jirovecii pneumonia, typically an opportunistic infection, is commonly associated with risk factors such as low CD4+ lymphocyte count, underlying malignancies, organ transplantation, or immunosuppressive medications. However, occurrences in healthy individuals without known risk factors are exceptionally rare and sparsely documented. In our retrospective analysis of a 42-year-old male without past medical history at Abderrahmane Mami Hospital, Tunisia, Pneumocystis jirovecii pneumonia was diagnosed. The patient presented with fever, productive cough, hemoptysis, and a decline in general health. Clinical examination revealed fever and hypoxemia, and imaging studies demonstrated bilateral necrotic alveolar opacities. Despite empirical antibiotics, nonresponse necessitated bronchoscopy, confirming Pneumocystis jirovecii. Treatment with oral Sulfamethoxazole-Trimethoprim yielded excellent outcomes. This case highlights the potential occurrence of Pneumocystis jirovecii pneumonia in immunocompetent individuals, underscoring the importance of direct microbiological methods in assessing suggestive clinical and radiological features.

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“…In literature, PCP is uncommon in immunocompetent subjects. 6 , 7 More rarely, few cases have been reported in immunocompetent without any underlying diseases like our patient.…”

Section: Discussionmentioning

confidence: 63%

Pneumocystis jirovecii pneumonia in a healthy immunocompetent patient: A case report and literature review

Rouis,

Moussa,

Houcine

et al. 2023

SAGE Open Medical Case Reports

View full text Add to dashboard Cite

show abstract

“…This patient also had one out of three AFB cultures positive for Mycobacterium avium complex, which was thought to be a contaminant. A second case involved an immunocompetent patient who presented with non-productive cough and dyspnoea 10. Imaging revealed multiple cavitary pulmonary nodules.…”

Section: Discussionmentioning

confidence: 99%

Pneumocystis jiroveciipneumonia presenting as a large pulmonary mass in a patient with AIDS

Bolling,

Beal,

Caulkins

et al. 2023

BMJ Case Rep

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Pneumocystis jiroveciipneumonia typically presents with diffuse bilateral infiltrates or ground-glass opacities. However, the radiographic pattern may be atypical. We report a case of a woman in her 40s who presented with multiple pulmonary masses and prolonged symptoms of non-productive cough, generalised weakness and fatigue. Serial chest CT performed prior to her presentation showed a large right lower lobe lung mass with multiple additional bilateral pulmonary nodules. Her workup revealed a new diagnosis of AIDS. Pathology of several CT-guided needle biopsies was consistent withPneumocystiswhich was confirmed by microbial DNA sequencing. No additional pathogens were identified. Her clinical symptoms and radiographs improved significantly with trimethoprim-sulfamethoxazole and treatment of her HIV infection. Clinicians should evaluate for underlying immunodeficiency and seek infectious disease and pulmonary consultation early for consideration of alternative diagnoses when patients present with cough, dyspnoea and atypical chest radiographs, and initial pathological examination is unrevealing.

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“…The most significant risk factors for PCP in HIV-free patients are the use of glucocorticoids and the presence of cell-mediated immune defects, which lead to changes in lung surfactant, thus predisposing the patient to pneumonia [41]. Previous studies have documented PCP in immunocompetent individuals [42][43][44][45][46]. A case of PCP in a non-HIV-infected Indian patient who has not undergone previous glucocorticoid treatment was described by Koshy et al (2015) [42].…”

Section: Discussionmentioning

confidence: 99%

“…There have been several reports of PCP in patients without underlying immunosuppressive disease. A study by Kano et al described five patients who developed PCP without any underlying immunosuppressive conditions, and in their literature review, they identified only 11 other reported cases [44]. However, the exact mechanisms that lead to the development of PCP in patients without evidence of immunosuppressive status remain unclear [45].…”

Section: Discussionmentioning

confidence: 99%

Study on the Prevalence of Pneumocystis jirovecii as a Causative Agent of Lung Pathology in People with Different Immune Status

et al. 2023

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Background: Pneumocystis pneumonia (PCP) commonly affects immunocompromised individuals, whereas in immunocompetent persons, it occurs relatively rarely, and in most cases, the Pneumocystis infection is detected as an asymptomatic colonization. The present study aimed to establish the prevalence of Pneumocystis jirovecii infection in human hosts with different immune status (immunocompromised and immunocompetent), using molecular diagnostic methods, and to compare their diagnostic value with that of classical staining methods. Methods: We used the collected-to-this-moment data from a prospective study on the prevalence of pneumocystosis among the Bulgarian population. Clinical specimens (including throat secretions, induced sputum, tracheal aspirates, and bronchoalveolar lavage) collected from 220 patients suspected of PCP (153 immunocompetent and 67 immunocompromised patients) were examined with microscopic staining methods and real-time PCR for detection of P. jirovecii. Results: DNA of the pathogen was detected in 38 (17%) specimens (32 immunocompromised patients and 6 immunocompetent subjects). From all 220 clinical samples examined by staining methods, only five (2%) P. jirovecii cysts were detected by the Gomori stain. All patients with PCP were treated with trimethoprim-sulfamethoxazole, but in ten of them (HIV-positive patients), the disease had a fatal outcome. Conclusions: This study is the first in Bulgaria including the main available laboratory methods for diagnosis of human pneumocystosis. Regarding the etiological diagnosis of PCP, in our study the sensitivity of real-time PCR was higher compared to the staining methods. The choice of a method for sample collection and examination has an important role in the efficiency of the laboratory diagnostics.

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Pneumocystis pneumonia causing cavitating lung nodules in an immunocompetent individual

Cited by 5 publications

References 16 publications

Pneumocystis jirovecii pneumonia in a healthy immunocompetent patient: A case report and literature review

Pneumocystis jirovecii pneumonia in a healthy immunocompetent patient: A case report and literature review

Pneumocystis jiroveciipneumonia presenting as a large pulmonary mass in a patient with AIDS

Study on the Prevalence of Pneumocystis jirovecii as a Causative Agent of Lung Pathology in People with Different Immune Status

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