Early onset Pneumocystis carinii pneumonia after allogeneic peripheral blood stem cell transplantation.
Pneumocystis carinii (P. carinii) is one of the major opportunistic pathogens responsible for hematopoietic stem cell transplantation (HSCT)-related pneumonias. Although trimethoprim-sulfamethoxazol (TMP/SMX) prophylaxis has been shown to prevent almost all P. carinii infections, 1%-2% of patients may still experience this complication. P. carinii pneumonia (PCP) is usually a late complication in patients receiving TMP/SMX prophylaxis, with most cases occurring later than 2 months post-transplant. We report a patient who developed early onset PCP after allogeneic peripheral blood stem cell transplantation (PBSCT) from an HLA-identical sibling donor. On day 12, the patient complained of dyspnea and cough. A chest X ray showed infiltrates in right upper lobe with bilateral pleural effusion. By the findings of Grocott stain on bronchoalveolar lavage fluid obtained on day 14, he was diagnosed as having PCP. Intravenous TMP/SMX failed to improve the lesion. This is the earliest onset PCP in the literature after HSCT despite the prophylactic administration of TMP/SMX before transplant.
Saito
T
T
Hematopoietic Stem Cell Transplantation Unit, National Cancer Center Hospital, Tokyo, Japan.
Seo
S
S
Kanda
Y
Y
Shoji
N
N
Ogasawara
T
T
Murakami
J
J
Tanosaki
R
R
Tobinai
K
K
Takaue
Y
Y
Mineishi
S
S
D019072:Antibiotic Prophylaxis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D017809:Fatal Outcome; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007107:Immune System / Q000187:drug effects; D016867:Immunocompromised Host; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology*; D011020:Pneumonia, Pneumocystis / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000628:therapy; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000209:etiology; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014182:Transplantation, Autologous / Q000009:adverse effects; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D014916:Whole-Body Irradiation
D003561:Cytarabine; D014750:Vincristine; D005047:Etoposide; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D011239:Prednisolone; D001215:Asparaginase; D008727:Methotrexate; D003630:Daunorubicin