title: Fatal Pneumocystis jirovecii pneumonia in a HIV-negative adult.
abstract: Pneumocystis jirovecii is responsible for P. jirovecii pneumonia (PJP) in immunocompromised individuals, with a recent rise of cases noted in non-HIV patients. A middle-aged man presented with new-onset cough, fever, hypoxia and tachypnoea. He was on a tapering course of dexamethasone for amiodarone-induced thyrotoxicosis. He developed worsening airspace disease necessitating mechanical ventilation. Bronchoalveolar lavage (BAL) fluid was positive for P. jirovecii and he was managed with trimethoprim/sulfamethoxazole and pentamidine, but succumbed to cardiorespiratory arrest. One-third of PJP cases occur in non-HIV patients, and have a higher morbidity and mortality. Most immunocompromised patients typically exhibit PJP during a corticosteroid taper. The accurate dose, duration or frequency of steroid use in not well established. Diagnosis of PJP in this population is more challenging due to lower BAL yield with alternate modalities such as serum/BAL β-d-glucan and PCR enhancing the yield. Further studies are needed to highlight PJP prophylaxis in patients with steroid use.
authors: Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: Toufik Mahfood
authors: TM
authors: Haddad
authors: Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors: Saraschandra
authors: S
authors: Vallabhajosyula
authors: Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: Muhammad Sarfraz
authors: MS
authors: Nawaz
authors: Division of Infectious Diseases, Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
authors: Renuga
authors: R
authors: Vivekanandan
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D017809:Fatal Outcome; D015658:HIV Infections / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D008168:Lung / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology; D016133:Polymerase Chain Reaction; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination