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Case Report: Fatal Pneumocystis jirovecii Infection in an Elderly Man Receiving Adjuvant Paclitaxel and Trastuzumab

Colin Vercueil^1,2, Hamza Ouaz¹, Emilie Schultz¹

¹Oncology Department, Hopitaux Civils de Colmar, Colmar, France.

Case Reports in Oncological Medicine

|May 21, 2025

Summary

This summary is machine-generated.

Pneumocystis jirovecii pneumonia (PJP) can occur in elderly cancer patients receiving chemotherapy, even without apparent immunosuppression. Vigilant monitoring is crucial for early detection and management of this opportunistic infection.

Keywords:

benefit risk assessment case reports male breast cancer opportunistic infection pneumocystis infection

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Area of Science:

Oncology
Infectious Diseases
Pulmonology

Background:

Pneumocystis jirovecii pneumonia (PJP) is typically seen in immunocompromised individuals.
Its incidence in solid tumor patients on chemotherapy is not well-defined.
Chemotherapy-induced lymphopenia may increase susceptibility to PJP.

Observation:

An 84-year-old male with HER2-positive breast cancer developed severe PJP post-chemotherapy (paclitaxel, trastuzumab).
The patient lacked prior immunosuppression or significant lymphopenia.
Symptoms included fever and dyspnea, with CT showing ground-glass opacities.

Findings:

Bronchoalveolar lavage confirmed Pneumocystis jirovecii DNA via PCR.
Despite treatment with sulfamethoxazole/trimethoprim and corticosteroids, the patient developed ARDS and died.
This case highlights PJP risk in elderly patients on adjuvant chemotherapy.

Implications:

Consider PJP risk in elderly cancer patients, even without evident immunosuppression.
Individualized risk assessment and monitoring are vital for managing opportunistic infections.
Current guidelines may need re-evaluation regarding PJP prophylaxis in specific patient groups.