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Pneumocystis Jirovecii Pneumonia in Two Immunosuppressed Non-HIV Infected Patients: A Clinical and Therapeutic
Weiran Li1, Mao Hua1, Jin Guo1
1Department of Clinical Medicine, School of Medicine, Qinghai University, Xining, People's Republic of China.
Abstract:
Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal infection that often occurs secondary to human immunodeficiency virus (HIV) infection. However, for non-HIV immunocompromised patients, such as those undergoing novel immunosuppressive treatments to manage malignancies, organ transplants, or connective tissue diseases, PJP is emerging as an increasing threat. The clinical manifestations of PJP in HIV-infected and non-HIV-infected patients differ significantly. In non-HIV-infected patients, PJP progresses rapidly and is challenging to diagnose, resulting in severe respiratory failure and a poor prognosis. We describe lymphocytopenia in two women who were recently treated with methotrexate, tacrolimus, and corticosteroids for immunosuppressive therapy following adjuvant chemotherapy for breast cancer and kidney transplantation. The initial examination included a high-resolution chest CT indicating atypical pneumonia, and treatment was initiated with trimethoprim - sulfamethoxazole and oxygen support. Subsequently, bronchoscopy and bronchoalveolar lavage with mNGS detected Pneumocystis jirovecii. After 3 weeks of treatment with cotrimoxazole, the two patients recovered significantly and their condition was stable.
Insights
Pneumocystis jirovecii pneumonia (PJP) is a growing threat in non-HIV patients undergoing immunosuppression. Early diagnosis and treatment are crucial for better outcomes in these challenging cases.
Area of Science:
- Medicine
- Infectious Diseases
- Pulmonology
Background:
- Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection primarily associated with human immunodeficiency virus (HIV).
- PJP is increasingly recognized in non-HIV immunocompromised patients, including those with malignancies, organ transplants, or autoimmune diseases.
- Clinical presentation and prognosis of PJP differ significantly between HIV-infected and non-HIV-infected individuals.
Observation:
- Two women developed PJP following immunosuppressive therapy (methotrexate, tacrolimus, corticosteroids) for breast cancer and kidney transplantation.
- Initial symptoms included atypical pneumonia on high-resolution chest CT.
- Bronchoscopy with bronchoalveolar lavage and mNGS confirmed Pneumocystis jirovecii.
Findings:
- PJP in non-HIV immunocompromised patients can progress rapidly and be difficult to diagnose.
- Prompt treatment with trimethoprim-sulfamethoxazole and oxygen support led to significant recovery in both patients.
- Next-generation sequencing (mNGS) proved effective in pathogen detection.
Implications:
- Highlights the importance of considering PJP in non-HIV immunocompromised patients presenting with respiratory symptoms.
- Emphasizes the need for timely diagnosis and appropriate treatment to improve patient outcomes.
- Suggests mNGS as a valuable tool for identifying Pneumocystis jirovecii in complex cases.
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