A Rare Case of Pneumocystis Pneumonia in HIV Patient on Glucocorticoid

Abstract

Pneumocystis pneumonia (PCP) is an opportunistic infection caused by Pneumocystis jirovecii. PCP due to immunosuppressive drugs is rarely reported in the literature. Herein we present a case of PCP in a 49-year-old patient who presented with progressive shortness of breath, dry cough, and low-grade fever. History revealed that he was taking prednisolone daily for his hyperactive airway disease. His temperature was 99^oF, and he had bilateral crackles in the lungs with resonant wheezing. High-resolution computed tomography showed diffuse ground-glass haze and cystic lesions in the middle and upper zones of both lungs. He was commenced on intravenous ceftriaxone and methylprednisolone based on provisional diagnosis of interstitial pneumonia. However, his condition worsened. His human immunodeficiency virus (HIV) test was reactive, and his CD4+ count was 275 cells/mm³. Bronchoalveolar lavage revealed PCP by direct immunofluorescent assay. Additional serum testing revealed marked elevation of beta-D-glucan, consistent with PCP diagnosis due to glucocorticoid use. Trimethoprim-sulfamethoxazole and voriconazole were initiated, and his respiratory symptoms started improving. His respiratory condition improved on day 9, and he was discharged with follow-up.

Keywords: glucocorticoid; hiv; pneumocystis jiroveci pneumonia.

Figure 1. Chest x-ray showing diffuse infiltrates in both lung fields.

Figure 2. HRCT showing diffuse ground-glass haze along with bronchiectasic changes predominantly in the mid zones (a, b), and multiple cystic lesions in all zones of both lungs (a-d).

HRCT; high-resolution computed tomography.