title: Pneumocystis jirovecii-induced chronic interstitial lung disease in Waldenström's macroglobulinemia.
abstract: Infections with Pneumocystis jirovecii can result in asymptomatic colonization or induce life threatening clinical symptoms. However, there appears to be a 'gray area' between colonization and severe pneumonia that remains underestimated so far. We describe a case with chronic interstitial lung disease and chronic cough that was attributed to P. jirovecii. The patient's history of chronic cough, although very likely being fostered by the underlying Waldenström's macroglobulinemia and interstitial lung disease, was most likely caused by P. jirovecii infection. This gives raise to the hypothesis that P. jirovecii infections do not necessarily induce life threatening pneumonia. Consequently, serial testing is required in eligible patients with positive PCR results in order to discriminate between colonization, 'gray zone' infection, and beginning pneumonia.
authors.affiliation: Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke, Lungenklinik, Ostmerheimer Str. 200, D-51109 Köln, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Windisch
authors.affiliation: Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke, Kardiologie, Ostmerheimer Str. 200, D-51109 Köln, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Meissner
authors.affiliation: Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke, Klinik für Radiologie, Ostmerheimer Str. 200, D-51109 Köln, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Goßmann
authors.affiliation: Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke, Institut für Pathologie, Ostmerheimer Str. 200, D-51109 Köln, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Brockmann
authors.affiliation: Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke, Institut für Pathologie, Ostmerheimer Str. 200, D-51109 Köln, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Schildgen
authors.affiliation: Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke, Institut für Pathologie, Ostmerheimer Str. 200, D-51109 Köln, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Schildgen
mesh_terms: D000368:Aged; D006801:Humans; D016867:Immunocompromised Host; D017563:Lung Diseases, Interstitial / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D008297:Male; D045363:Pneumocystis carinii / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology*; D008258:Waldenstrom Macroglobulinemia / Q000276:immunology / Q000382:microbiology* / Q000473:pathology
keywords: Pneumocystis jirovecii; Waldenström's macroglobulinemia; disease/indication: chronic Pneumocystis infection; dyspnea; fatigue; lung fibrosis; pathology/symptoms: chronic cough; treatment: sulfamethoxazole trimethoprim prophylaxis