Disseminated cryptococcal disease complicating steroid therapy for Pneumocystis carinii pneumonia in a patient with AIDS

Abstract

Recent studies have suggested that steroid therapy may reduce the morbidity and mortality of HIV-associated Pneumocystis carinii pneumonia (PCP) in a select population of patients. However, the risks of steroid therapy for this group have not been well defined. We describe the case of a patient admitted with severe PCP whose treatment included high-dose steroids. During his hospitalization, overwhelming cryptococcal disease developed, contributing to his death. We postulate that the rapidity of progression was due, in part, to the steroid therapy. We have also reviewed the literature. We recommend screening for cryptococcal infection before beginning steroid therapy.