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Acute Pneumocystis jirovecii Pneumonia Due to Absolute Lymphopenia

Eric Hilker1, Sachin M Patil2, Rodger Wilhite3

  • 1Department of Internal Medicine, University of Missouri School of Medicine, Columbia, USA.

Cureus
|April 4, 2022
PubMed

Insights

Pneumocystis pneumonia (PCP) is a fungal infection. This case highlights a rare occurrence of PCP in an elderly rheumatoid arthritis patient presenting with respiratory failure due to immunosuppression.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Rheumatology

Background:

  • Pneumocystis pneumonia (PCP) is an opportunistic fungal infection.
  • PCP is an AIDS-defining illness in HIV-infected individuals.
  • PCP incidence is increasing in HIV-negative patients due to immunosuppressive therapies.

Observation:

  • This report details a rare case of PCP in an elderly female with rheumatoid arthritis (RA).
  • The patient had recently undergone resection for lung adenocarcinoma and was on low-dose methotrexate and prednisone.
  • She presented with acute hypoxic respiratory failure and absolute lymphopenia.

Findings:

  • The patient's presentation of PCP differed from typical cases in HIV-infected individuals.
  • Immunosuppression from RA treatment, not HIV, was the predisposing factor.
  • Absolute lymphopenia was identified as a key indicator.

Implications:

  • This case underscores the importance of considering PCP in immunocompromised patients, even without HIV.
  • It highlights the variability in PCP presentation and severity in non-HIV populations.
  • Early recognition and diagnosis are crucial for managing PCP in patients with autoimmune diseases and those on immunosuppressants.
Keywords:
hiv negativelymphopeniapneumocystis jiroveci pneumoniaprednisonerheumatoid arthritis

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