title: Co-infection with invasive pulmonary aspergillosis and Pneumocystis jirovecii pneumonia after corticosteroid therapy.
abstract: A 95-year-old man with chronic obstructive pulmonary disease and chronic hepatitis C virus infection was treated for acute lung injury caused by Chlamydophila pneumoniae with antibiotics and high-dose corticosteroids. In total, 7,500 mg methylprednisolone and 680 mg prednisolone were administered over 21 days. However, respiratory failure progressed, and chest computed tomography (CT) scan showed bilateral ground-glass opacity and cavity-forming consolidation in the right upper lobe. Despite intensive therapy, the patient died of multiple organ failure on day 7. CT-guided necropsy was performed, and pathological examination revealed invasive pulmonary aspergillosis and Pneumocystis jirovecii pneumonia. Invasive pulmonary aspergillosis and P. jirovecii pneumonia are both life-threatening opportunistic fungal infections. Co-infection of these organisms is rare but possible if the patient is in an extremely immunocompromised state. Short-term but high-dose systemic corticosteroid therapy was considered to be the risk factor in this case. We should pay more attention to immunocompromised hosts who might be suffering from co-infection of opportunistic infections. Moreover, we need to consider preventive measures in such high-risk cases.
authors.affiliation: Emergency Unit and Critical Care Center, Tsuyama Central Hospital, 1756 Kawasaki, Tsuyama, Okayama, Japan, e_dai_for_all@hotmail.com
authors.forename: Hideharu
authors.initials: H
authors.lastname: Hagiya
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Miyake
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kokumai
authors.forename: Tomoko
authors.initials: T
authors.lastname: Murase
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kuroe
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Nojima
authors.forename: Junichi
authors.initials: J
authors.lastname: Sugiyama
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Naito
authors.forename: Shingo
authors.initials: S
authors.lastname: Hagioka
authors.forename: Naoki
authors.initials: N
authors.lastname: Morimoto
mesh_terms: D055371:Acute Lung Injury / Q000188:drug therapy / Q000382:microbiology; D000369:Aged, 80 and over; D017809:Fatal Outcome; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000382:microbiology*; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000382:microbiology*; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone; D008775:Methylprednisolone