Pneumocystis pneumonia in patients with cancer: clinical setting

The most common clinical setting for the development of pneumocystis pneumonia in the United States is in a patient successfully treated with combination chemotherapy, usually including steroids, for a hematologic malignancy. The pneumonia is most likely to occur in the acute form during the reduction or withdrawal of chemotherapy and is the most common cause of infectious death in such cancer patients when they are in a clinical remission. The disease also develops in such patients on therapy who have uncontrolled growth of their tumor and occasionally in patients with other types of solid tumors. Given the appropriate clinical setting, all attempts should be made to establish the diagnosis histologically, but if this is not possible, empirical treatment with pentamidine isethionate is indicated.