Challenges in the diagnosis and management of severe Pneumocystis jirovecii pneumonia in a non-HIV-infected patient - A case report
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Abstract
A 64-year-old woman was referred to our hospital due to progressive dypnoea for the past week, combined with fever and type 1 respiratory failure. White blood cell count and procalcitonin level were normal. The Chest X-ray showed bilateral disseminated pulmonary infiltrates. Within the next 24 hours the patient developed a severe ARDS. A first diagnostic work-up for typical and atypical pathogens as well as serological tests for CMV, RSV, HIV and HSV were negative. Analysis of a second bronchoalveolar lavage fluid revealed Pneumocystis jiroveci DNA. The patient was successfully treated with trimethoprim-sulfamethoxazole and off label use with caspofungin. The cause of the infection was a six week treatment with dexamethasone. The patient developed a toxic epidermal necrolysis during further course, but completely recovered.
Pneumonia with Pneumocystis jirovecii must also be taken into account in non-HIV patients, whenever there are any indications that cellular immunity may be depressed.
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Copyright (c) 2018 Taubert M, et al.
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Mansharamani NG, Garland R, Delaney D, Koziel H. Management and outcome patterns for adult Pneumocystis carinii pneumonia, 1985 to 1995: comparison of HIV-associated cases to other immunocompromised states. Chest. 2000; 118: 704-711. Ref.: https://goo.gl/EPe8B7
Bellani G, Laffey JG, Pham T, Fan E, Brochard L, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016; 315: 788-800. Ref.: https://goo.gl/LMG3Dv
Lobo ML,Esteves F, de Sousa B, Cardoso F, Cushion MT, et al. Therapeutic Potential of Caspofungin Combined with Trimethoprim-Sulfamethoxazole for Pneumocystis Pneumonia: A Pilot Study in Mice. PLoS One., 2013; 8: e70619. Ref.: https://goo.gl/N9annU
Sekula P, Dunant A, Mockenhaupt M, Naldi L, Bouwes Bavinck JN, et al. Comprehensive survival analysis of a cohort of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. J. Invest. Dermatol. 2013; 133: 1197-204. Ref.: https://goo.gl/JRc6T8
Li H, Huang H, He H. Successful treatment of severe Pneumocystis pneumonia in an immunosuppressed patient using caspofungin combined with clindamycin: a case report and literature review. BMC. Pulm. Med. 2016; 16: 144. Ref.: https://goo.gl/wuvPtt