Extrapulmonary pneumocystosis in an antiretroviral therapy-naïve, HIV-positive patient
Makoto Hasegawa1, Yuji Ito2, Yasuhiro Osugi3
1Department of General Internal Medicine, Fujita Health University Okazaki Medical Center, Japan.
Abstract:
Pneumocystis jirovecii is a common opportunistic fungal pathogen that commonly affects immunocompromised individuals and can cause P. jirovecii pneumonia. Extrapulmonary P. jirovecii infections are extremely rare. Herein, we present a case of an HIV-positive, antiretroviral therapy-naïve patient who had extrapulmonary pneumocystosis (EPC). He presented with complaints of decreased appetite, abdominal fullness, and weight loss. Computed tomography (CT) revealed multiple low-attenuation masses in the spleen, liver, and both adrenal glands but no pulmonary involvement. A core-needle biopsy of a splenic lesion confirmed the diagnosis of EPC. The patient was initiated on intravenous trimethoprim-sulfamethoxazole (TMP-SMX) and CT-guided percutaneous catheter drainage of the splenic lesion was performed. Intravenous TMP-SMX therapy was completed in 3 weeks and intravenous pentamidine (250 mg daily) therapy was commenced. Pentamidine was completed after 3 weeks, and antiretroviral treatment (ART) was initiated with dolutegravir 50 mg and Descovy HT (emtricitabine [200 mg] and tenofovir alafenamide fumarate [25 mg]). After starting ART, the patient's clinical condition improved, and the abscesses gradually reduced. TMP-SMX is commonly used to treat EPC; however, there is no standard method of treatment. ART may become the key to EPC treatment in individuals with HIV infection.
Insights
Extrapulmonary Pneumocystis jirovecii infections are rare. This case highlights successful treatment of disseminated Pneumocystis jirovecii pneumonia in an HIV-positive patient using antifungals and antiretroviral therapy.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Immunocompromised Host Pathologies
Background:
- Pneumocystis jirovecii is an opportunistic fungal pathogen causing Pneumocystis pneumonia in immunocompromised individuals.
- Extrapulmonary Pneumocystis jirovecii infections (EPC) are exceptionally rare, with limited established treatment protocols.
Observation:
- A case of an HIV-positive, antiretroviral therapy-naïve patient presenting with extrapulmonary pneumocystosis involving spleen, liver, and adrenal glands.
- Computed tomography (CT) revealed multiple splenic, hepatic, and adrenal masses, with no pulmonary involvement.
- Diagnosis was confirmed via core-needle biopsy of a splenic lesion.
Findings:
- The patient received intravenous trimethoprim-sulfamethoxazole (TMP-SMX) and pentamidine, alongside CT-guided percutaneous drainage of a splenic lesion.
- Initiation of antiretroviral therapy (ART) with dolutegravir and Descovy HT led to clinical improvement and gradual reduction of abscesses.
- While TMP-SMX is a common treatment for EPC, standard treatment methods are not well-defined.
Implications:
- Antiretroviral therapy (ART) may play a crucial role in managing extrapulmonary pneumocystosis in HIV-infected individuals.
- This case underscores the importance of considering rare presentations of opportunistic infections in immunocompromised patients.
- Further research is needed to establish standardized treatment guidelines for extrapulmonary pneumocystosis.
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