Pneumocystis jirovecii and Cytomegalovirus Co-Infection in AIDS Patients

Joana Acar, Germana da Rocha Torres, Johanna Wagner Poti Sales, Bruna Leite Marques, Renato Azambuja, Luiz Carlos Aguiar Vaz, Claudia Henrique da Costa, Rogerio Rufino

Abstract


A case report of a young woman with insidious dyspnea, cough and weight loss that began 3 months before hospitalization. She referred to occasional cough, wheezing, and fever during the last 2 years. Over one year before, she performed a chest CT that showed diffuse ground-glass opacity (GGO) distributed in both lungs with predominance in the upper and middle areas. She immediately received standardized treatment with sulfamethoxazole-trimethoprim (SMZ-TMP), and ELISA and Western Blot tests for AIDS were performed, and both were positive. Pneumocystis Jirovecci (PCJ) staining and PCR from bronchoalveolar lavage were negative. The GGO seen in CT was inconclusive. After 10 days of treatment, she progressed to being respiratory insufficient. A lung biopsy was done and revealed co-infection of cytomegalovirus (CMV) and PCJ. Although first line therapy for both PCJ and CMV was instituted early, she had an unfavorable outcome. Despite following the recommendations for diagnosis and treatment of community-acquired pneumonia in immunosuppressed patients, the patient died. The use of molecular biomethods for recognizing sulfur resistance is not usually performed in daily practice and an old question regarding the aggressiveness of co-infection of PCJ and CMV returned in this case.




J Med Cases. 2013;4(6):402-406
doi: https://doi.org/10.4021/jmc1249w

Keywords


Pneumocystis pneumonia; Pneumocystosis; Acquired immunodeficiency syndrome; Cytomegalovirus; Ground-glass opacity; Oral candidiasis

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