Caspofungin Combined With TMP/SMZ in Treatment of Intractable Acute Pneumocystis jirovecii Pneumonia in Renal Transplant Recipients: Case Report and Literature Review

Abstract

Pneumocystis jirovecii pneumonia (PJP) is a potential life-threatening opportunistic infection that predominantly affects immunocompromised individuals, such as those with human immunodeficiency virus or organ transplant recipients. The treatment of PJP, particularly severe cases, remains challenging, as standardized treatment therapies often require prolonged durations without achieving significant clinical improvement. The present study describes the case of a 48-year-old female patient who suffered from severe refractory PJP following renal transplantation. Despite 3 weeks of conventional treatment, computed tomography images revealed persistent lung infection, and the PJP nucleic acid test remained positive. However, after initiating combination therapy with caspofungin and trimethoprim/sulfamethoxazole (TMP/SMZ) for 48 days, the PJP nucleic acid test yielded negative results, and marked resolution was observed in lung imaging. On the whole, in the management of PJP, particularly that of severe refractory cases following organ transplantation, extending the treatment duration may lead to improved outcomes. The case described herein demonstrates the potential efficacy of prolonged treatment with a combination of caspofungin and TMP/SMZ in facilitating infection clearance and promoting clinical recovery in non-HIV patients with PJP.

Keywords: Pneumocystis jirovecii pneumonia (PJP); TMP/SMZ; caspofungin; renal transplant.

FIGURE 1

CT scan of the chest. (A) Upon admission, an axial CT scan of the chest revealed diffuse bilateral ground‐glass opacities, indicative of alveolitis associated with Pneumocystis jirovecii pneumonia. (B) At 1 day following transfer to the ICU, the ground‐glass opacities in the lung were notably aggravated. (C) At 8 days following transfer to the ICU, the further progression of the ground‐glass opacities was observed. (D) At 15 days following transfer to the ICU, persistent and extensive ground‐glass opacities were evident. (E) At 20 days following transfer to the ICU, the ground‐glass opacities exhibited additional worsening. (F) At 28 days following transfer to the ICU, the diffuse ground‐glass opacities remained prominent, reflecting the refractory nature of the infection. CT, computed tomography; ICU, intensive care unit.

FIGURE 2

Chest computed tomography scan performed at 37 days following transfer to the intensive care unit. (A) Pneumothorax and indwelling thoracic closed drainage tube and (B) marked improvement in the ground‐glass opacities was observed in both lungs.

FIGURE 3

A comprehensive timeline flowchart summarizing the patient's clinical course and therapeutic interventions.