title: Fatal pulmonary co-infection with pneumocystis and cytomegalovirus in a patient with acquired immunodeficiency syndrome.
abstract: A 33-year-old homosexual Japanese man who admitted to having sex with men presented with a two-week history of dyspnea and fever. Chest imaging showed diffuse pulmonary frosted-glass-like shadows. A blood test revealed positive HIV antibodies with a CD4 cell count of 66/μL. Bronchoalveolar lavage identified pneumocystis. Although the patient exhibited a transient response to anti-pneumocystis treatment and mega-dose steroid pulse therapy, he eventually died from respiratory failure. An autopsy suggested massive cytomegalovirus and pneumocystis pneumonitis. The pulmonary co-infection with cytomegalovirus may have been worsened by the use of mega-dose steroids, and such therapy should be avoided in patients with a high HIV viral load and low CD4 count.
authors.affiliation: Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Japan.
authors.forename: Eri
authors.initials: E
authors.lastname: Chuganji
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Abe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kobayashi
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Nakano
authors.forename: Takao
authors.initials: T
authors.lastname: Kanai
authors.forename: Gen
authors.initials: G
authors.lastname: Ohara
authors.forename: Norio
authors.initials: N
authors.lastname: Takayashiki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Noguchi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Morishita
authors.forename: Makoto
authors.initials: M
authors.lastname: Aoki
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis* / Q000821:virology; D000328:Adult; D000908:Antibodies, Fungal / Q000032:analysis; D000914:Antibodies, Viral / Q000032:analysis; D060085:Coinfection; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000821:virology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006678:HIV; D006801:Humans; D008297:Male; D011010:Pneumocystis / Q000276:immunology; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000382:microbiology; D014057:Tomography, X-Ray Computed
chemical_list: D000908:Antibodies, Fungal; D000914:Antibodies, Viral