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Pneumocystis hepatitis and choroiditis despite successful aerosolized pentamidine pulmonary prophylaxis
1Department of Medicine, University of Washington, Seattle.
Abstract:
A patient who developed Pneumocystis carinii hepatitis and choroiditis despite receiving prophylactic pentamidine therapy by aerosol is described. Liver biopsy showed histology typical of Pneumocystis hepatitis, but his respiratory status was stable and his lungs were free of P carinii organisms on BAL. Thus, inhaled pentamidine prophylaxis did not prevent extrapulmonary pneumocystosis. Patients receiving pentamidine prophylaxis with unexplained symptoms should undergo investigation for possible extrapulmonary P carinii infection.
Insights
Inhaled pentamidine prophylaxis failed to prevent Pneumocystis carinii infection in the liver and eye. This highlights the risk of extrapulmonary pneumocystosis even with preventative therapy.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Immunocompromised Host Research
Background:
- Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection in immunocompromised individuals.
- Prophylactic aerosolized pentamidine is used to prevent PCP.
- Extrapulmonary Pneumocystis infections can occur, but are less common.
Observation:
- A patient receiving aerosolized pentamidine prophylaxis developed Pneumocystis carinii hepatitis and choroiditis.
- Liver biopsy confirmed Pneumocystis hepatitis.
- Bronchoalveolar lavage (BAL) showed no Pneumocystis carinii in the lungs, and the patient's respiratory status was stable.
Findings:
- Aerosolized pentamidine prophylaxis was ineffective in preventing extrapulmonary Pneumocystis carinii infection in this case.
- The development of hepatitis and choroiditis despite prophylaxis indicates a failure of inhaled pentamidine to provide complete protection.
- This case demonstrates that extrapulmonary pneumocystosis can occur even when pulmonary infection is absent.
Implications:
- Patients on pentamidine prophylaxis with unexplained symptoms require investigation for extrapulmonary Pneumocystis carinii.
- Current prophylactic strategies may not fully prevent disseminated Pneumocystis infections.
- Further research is needed to understand the mechanisms and prevention of extrapulmonary pneumocystosis.