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A Rare Case of Multipathogenic Pneumonia in a Patient With Human Immunodeficiency Virus

Ahmad Al-Shyoukh1, Moustafa Younis2, Mohamed Warsame3

  • 1Internal Medicine, University of Missouri-Kansas City School of Medicine/Saint Luke's Health System, Kansas City, USA.

Cureus
|August 26, 2020
PubMed

Insights

A human immunodeficiency virus (HIV) patient non-compliant with antiretroviral therapy (ART) developed severe pneumonia from four pathogens. Despite treatment, the patient succumbed to the disseminated infection.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Immunology

Background:

  • Antiretroviral therapy (ART) has reduced opportunistic infections in human immunodeficiency virus (HIV) patients.
  • Pulmonary infections persist as a major cause of illness and death in individuals with HIV.
  • The range of lung diseases in HIV patients includes infections by diverse bacterial, fungal, viral, and parasitic agents.

Observation:

  • A 65-year-old female with HIV, not adhering to ART, presented with melena, fatigue, shortness of breath, and coughing up blood.
  • Extensive diagnostic workup revealed pneumonia caused by Strongyloides stercoralis, Pneumocystis jirovecii, Cytomegalovirus (CMV), and Pseudomonas aeruginosa.

Findings:

  • The patient received trimethoprim-sulfamethoxazole, steroids, and ivermectin for the polymicrobial pneumonia.
  • Despite aggressive treatment, the patient's condition failed to improve.

Implications:

  • This case highlights the severe risks of untreated HIV and non-adherence to ART.
  • Polymicrobial pulmonary infections can be rapidly fatal in immunocompromised individuals.
  • The complexity of co-infections necessitates a broad diagnostic and therapeutic approach in HIV-associated lung disease.
Keywords:
cytomegalovirus penumoniahuman immunodeficiency virusopportunistic infectionpneumocystis carinii pneumoniastrongyloides stercoralis

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