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AIDS-related extrapulmonary Pneumocystis carinii infection presenting as a solitary rectal ulcer
E M Yoshida1, D Filipenko, P Phillips
1Department of Medicine, University of British Columbia, Vancouver.
Abstract:
Extrapulmonary infection with Pneumocystis carinii, although uncommon, is increasingly recognized. Use of aerosolized pentamidine versus a systemic medication is thought to be a contributing factor due to the low concentrations of drug that are incapable of suppressing systemic infection. Infection with P carinii has been reported in every organ system including the gastrointestinal system. A 28-year-old acquired immunodeficiency syndrome patient receiving prophylaxis with aerosolized pentamidine who presented with a solitary rectal ulcer is reported. Initial biopsy was characteristic of extrapulmonary P carinii infection, with numerous organisms present. Occasional cytomegalovirus inclusion bodies were noted which may have been a copathogen but which were not treated. Treatment with intravenous pentamidine resulted in documented eradication of P carinii and complete resolution of the ulcer. Although lower gastrointestinal pneumocystosis has been described without ulceration, this is the first description of rectal ulceration presenting as the initial manifestation of extrapulmonary pneumocystosis.
Insights
Extrapulmonary Pneumocystis carinii infection can manifest as rectal ulcers, particularly in patients on aerosolized pentamidine prophylaxis. Intravenous pentamidine effectively treated this rare gastrointestinal presentation.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Immunology
Background:
- Extrapulmonary Pneumocystis carinii (PCP) infections are increasingly recognized, potentially linked to aerosolized pentamidine prophylaxis.
- PCP can affect any organ system, including the gastrointestinal tract, though less commonly.
Observation:
- A 28-year-old HIV/AIDS patient on aerosolized pentamidine prophylaxis presented with a solitary rectal ulcer.
- Biopsy confirmed PCP infection with numerous organisms; cytomegalovirus inclusions were also noted but untreated.
Findings:
- Treatment with intravenous pentamidine led to documented eradication of P carinii.
- Complete resolution of the rectal ulcer was observed following treatment.
Implications:
- This case represents the first documented instance of rectal ulceration as the initial manifestation of extrapulmonary PCP.
- Highlights the importance of considering PCP in the differential diagnosis of gastrointestinal lesions, even with prophylaxis.