title: Clinical picture of Pneumocystis jiroveci pneumonia in cancer patients.
abstract: BACKGROUND
  Pneumocystis pneumonia (PCP) is common in patients with HIV infection but may also occur in patients with other causes of immunodeficiency, including hematologic and solid malignancies.
  
  
  METHODS
  To better describe the clinical picture of PCP as to maintain a high level of suspicion in adequate cases, we studied 56 cancer patients with PCP and compared them to 56 cancer patients with bacterial pneumonia.
  
  
  RESULTS
  Among 56 PCP patients, 44 patients (78.6%) had hematologic malignancies (18 recipients of bone marrow transplantation) and 12 patients had solid tumors. The time since diagnosis was 24 months (range, 4 to 49 months). All patients with solid tumors and 20 patients (45.4%) with hematologic malignancies were receiving steroids. Only six patients were receiving PCP prophylaxis. The main symptoms were fever (85.7%), dyspnea (78.6%), and cough (57.1%). Time from symptom onset was 7 days (range, 3 to 14 days). PCP presented as severe pneumonia (Pao(2), 58 mm Hg [range, 50 to 70 mm Hg]) with bilateral interstitial infiltrates (80.4%) and bilateral ground-glass attenuation (89.3%) by CT. Of the 24 ICU patients (42.9%), 16 patients (19.6%) required mechanical ventilation. Eleven patients (19.6%) died. Compared to 56 patients with bacterial pneumonia, PCP patients were more likely to have non-Hodgkin lymphoma and be receiving long-term steroids; they had longer times since diagnosis, longer symptom duration, higher frequencies of fever and of diffuse lung disease (diffuse crackles, bilateral infiltrates, and hypoxemia), higher frequency of ground-glass opacities, and lower frequency of pleural involvement.
  
  
  CONCLUSIONS
  PCP presents as subacute, febrile, hypoxemic, and diffuse pulmonary involvement in patients with solid tumors or hematologic malignancies receiving long-term steroids.
authors.affiliation: Medical Intensive Care Unit, Assistance Publique, Hôpitaux de Paris, Saint-Louis Teaching Hospital, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bollée
authors.forename: Claudine
authors.initials: C
authors.lastname: Sarfati
authors.forename: Guillaume
authors.initials: G
authors.lastname: Thiéry
authors.forename: Anne
authors.initials: A
authors.lastname: Bergeron
authors.forename: Sandra
authors.initials: S
authors.lastname: de Miranda
authors.forename: Jean
authors.initials: J
authors.lastname: Menotti
authors.forename: Nathalie
authors.initials: N
authors.lastname: de Castro
authors.forename: Abdellatif
authors.initials: A
authors.lastname: Tazi
authors.forename: Benoît
authors.initials: B
authors.lastname: Schlemmer
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D019337:Hematologic Neoplasms / Q000453:epidemiology*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D045363:Pneumocystis carinii; D018410:Pneumonia, Bacterial / Q000453:epidemiology; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies