Pneumocystis jirovecii-induced chronic interstitial lung disease in Waldenström's macroglobulinemia
Wolfram Windisch1, Axel Meissner2, Axel Goßmann3
1Kliniken der Stadt Köln gGmbH, Klinikum der Privaten Universität Witten/Herdecke, Lungenklinik, Ostmerheimer Str. 200, D-51109 Köln, Germany.
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.
Insights
Pneumocystis jirovecii infections can exist in a spectrum from colonization to severe pneumonia. This case highlights a potential
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Pneumocystis jirovecii (PJP) is an opportunistic pathogen.
- PJP infections range from asymptomatic colonization to life-threatening pneumonia.
- A clinical "gray zone" between colonization and severe PJP pneumonia is often underestimated.
Observation:
- A case of chronic interstitial lung disease and chronic cough was attributed to P. jirovecii.
- The patient's chronic cough, potentially exacerbated by Waldenström's macroglobulinemia and ILD, was likely caused by P. jirovecii.
Findings:
- Pneumocystis jirovecii infections may not always manifest as severe pneumonia.
- This suggests a spectrum of PJP disease beyond simple colonization or critical illness.
Implications:
- Serial testing is crucial for differentiating PJP colonization, "gray zone" infections, and early pneumonia.
- This approach aids in appropriate patient management and treatment strategies.
- Further research is needed to define the clinical significance of the PJP "gray zone".
Related Concept Videos
01:29Pneumonia II: Pathophysiology
01:20Chronic Obstructive Pulmonary Disease-II: Pathophysiology
Chronic Inflammation
01:24Chronic Obstructive Pulmonary Disease
Smoking is a primary risk factor for COPD, with over 80% of patients having a history of it. Patients typically experience progressive dyspnea or labored breathing, frequent coughing, and recurrent pulmonary infections. Many eventually succumb to respiratory failure, characterized by...
01:20Chronic Obstructive Pulmonary Disease-I: Introduction
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History