Limits...
Unsuspected Pneumocystis pneumonia in an HIV-seronegative patient with untreated lung cancer: circa case report.

Chuang C, Zhanhong X, Yinyin G, Qingsi Z, Shuqing Z, Nanshan Z - J Med Case Rep (2007)

Bottom Line: A 43-year-old woman presented with prolonged fever, progressive dyspnoea, diffuse alveolar and interstitial infiltrates.Malignant cells were found on sputum cytology, confirming the diagnosis of lung cancer.Pneumocystis jiroveci was later found in the sputum but she proved to be HIV negative.

View Article: PubMed Central - HTML - PubMed

Affiliation: Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510012, China, . skinblack1966@yahoo.com.cn.

ABSTRACT

Background: Patients with solid malignant tumours are at increased risk of Pneumocystis jiroveci infection from immunosuppression as a result of chemotherapy and/or radiotherapy, but active Pneumocystis pneumonia (PCP) in untreated lung cancer is uncommon.

Case presentation: A 43-year-old woman presented with prolonged fever, progressive dyspnoea, diffuse alveolar and interstitial infiltrates. Malignant cells were found on sputum cytology, confirming the diagnosis of lung cancer. She had been treated with corticosteroids and antibiotics but did not receive chemotherapy or radiotherapy. Pneumocystis jiroveci was later found in the sputum but she proved to be HIV negative.

Conclusion: Unsuspected PCP can occur in chemotherapy and radiotherapy-naïve, HIV-seronegative patients with lung cancer. The complex clinicoradiological manifestations of PCP with underlying lung cancer can lead to delay in diagnosis and may worsen the prognosis.

No MeSH data available.


Related in: MedlinePlus

Methamine silver stain demonstrating clusters of Pneumocystis jiroveci cysts in the sputum (×100)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2147019&req=5

Figure 3: Methamine silver stain demonstrating clusters of Pneumocystis jiroveci cysts in the sputum (×100)

Mentions: Four days after admission, clusters of Pneumocystis jiroveci cysts were unexpectedly and repeatedly identified in her sputa using methamine silver stain (Fig. 3). The patient was therefore diagnosed with PCP. Oral TMP-SMX (2 double-strength tab, tid, as intravenous pentamdine or trimethoprim/sulfamethoxazole was not available in Guangzhou), with intravenous methylprednisolone 40 mg qd as adjunctive therapy, was initiated with the original antibiotic regimen still continued. Further investigations found that her peripheral blood CD4 T lymphocyte was 189/μL with CD4/CD8 ratio as 1.4: 1, C reactive protein (CRP) was 26 mg/L (0–8 mg/L), serum lactate dehydrogenase (LDH) was 371 IU/L (35–90 IU/L). She tested negative for HIV and cytomegalovirus. Her family members including her husband and children were also HIV- seronegative. When 7 days' treatment with co-trimoxazole failed to alleviate her respiratory distress and high fever, her family opted to withdraw her from therapy and obtained her discharge. She died of respiratory failure three days later.


Unsuspected Pneumocystis pneumonia in an HIV-seronegative patient with untreated lung cancer: circa case report.

Chuang C, Zhanhong X, Yinyin G, Qingsi Z, Shuqing Z, Nanshan Z - J Med Case Rep (2007)

Methamine silver stain demonstrating clusters of Pneumocystis jiroveci cysts in the sputum (×100)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2147019&req=5

Figure 3: Methamine silver stain demonstrating clusters of Pneumocystis jiroveci cysts in the sputum (×100)
Mentions: Four days after admission, clusters of Pneumocystis jiroveci cysts were unexpectedly and repeatedly identified in her sputa using methamine silver stain (Fig. 3). The patient was therefore diagnosed with PCP. Oral TMP-SMX (2 double-strength tab, tid, as intravenous pentamdine or trimethoprim/sulfamethoxazole was not available in Guangzhou), with intravenous methylprednisolone 40 mg qd as adjunctive therapy, was initiated with the original antibiotic regimen still continued. Further investigations found that her peripheral blood CD4 T lymphocyte was 189/μL with CD4/CD8 ratio as 1.4: 1, C reactive protein (CRP) was 26 mg/L (0–8 mg/L), serum lactate dehydrogenase (LDH) was 371 IU/L (35–90 IU/L). She tested negative for HIV and cytomegalovirus. Her family members including her husband and children were also HIV- seronegative. When 7 days' treatment with co-trimoxazole failed to alleviate her respiratory distress and high fever, her family opted to withdraw her from therapy and obtained her discharge. She died of respiratory failure three days later.

Bottom Line: A 43-year-old woman presented with prolonged fever, progressive dyspnoea, diffuse alveolar and interstitial infiltrates.Malignant cells were found on sputum cytology, confirming the diagnosis of lung cancer.Pneumocystis jiroveci was later found in the sputum but she proved to be HIV negative.

View Article: PubMed Central - HTML - PubMed

Affiliation: Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510012, China, . skinblack1966@yahoo.com.cn.

ABSTRACT

Background: Patients with solid malignant tumours are at increased risk of Pneumocystis jiroveci infection from immunosuppression as a result of chemotherapy and/or radiotherapy, but active Pneumocystis pneumonia (PCP) in untreated lung cancer is uncommon.

Case presentation: A 43-year-old woman presented with prolonged fever, progressive dyspnoea, diffuse alveolar and interstitial infiltrates. Malignant cells were found on sputum cytology, confirming the diagnosis of lung cancer. She had been treated with corticosteroids and antibiotics but did not receive chemotherapy or radiotherapy. Pneumocystis jiroveci was later found in the sputum but she proved to be HIV negative.

Conclusion: Unsuspected PCP can occur in chemotherapy and radiotherapy-naïve, HIV-seronegative patients with lung cancer. The complex clinicoradiological manifestations of PCP with underlying lung cancer can lead to delay in diagnosis and may worsen the prognosis.

No MeSH data available.


Related in: MedlinePlus