A RARE COMPLICATION: ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) INDUCED BY SEVERE PNEUMOCYSTIS CARINII PNEUMONIA (PCP)
DOI:
https://doi.org/10.61841/yhyj9h89Keywords:
Pneumocystis pneumonia, cute respiratory distress syndrome, HIV/AIDSAbstract
Introduction: Pneumocystis pneumonia (PCP) represents a prevalent opportunistic infection among individuals with HIV, posing a significant risk of mortality. The occurrence of acute respiratory distress syndrome (ARDS) as a consequence of PCP further accentuates the gravity and intricacy of this pulmonary infection.
Objective: This case report aims to discuss the management of the rare complication of ARDS induced by severe PCP in a 36-year-old man with HIV.
Case Presentation: A 36-year-old male teacher, presented with worsening dyspnea, intermittent fever, and a productive cough persisting for two weeks, along with weight loss and fatigue. Initial diagnostic impressions included pulmonary tuberculosis with pneumonia. Treatment involved oxygen therapy, fluid administration, and medication. Laboratory tests showed leukocytosis, elevated blood glucose, and abnormal liver function. Subsequent investigations confirmed HIV infection. Chest X-ray revealed severe bilateral pneumonia and possible ARDS, leading to transfer to the Intensive Care Coronary Unit for further management.
Discussion: The diagnosis of severe Pneumocystis jirovecii pneumonia (PCP) underscores the importance of recognizing PCP as a significant clinical concern, especially in HIV patients. Diagnostic challenges, such as late HIV diagnosis, highlight the need for timely screening and intervention. Management involved a multidisciplinary approach, including pulmonologists and cardiologists. Despite treatment adjustments, some patients experience clinical deterioration, necessitating careful management strategies like antiretroviral (ARV) therapy and respiratory support. This case underscores the complexity of managing PCP-related ARDS and the crucial role of timely intervention and comprehensive care.
Conclusion: Severe PCP led to ARDS in an HIV-infected patient due to inflammation and lung damage, exacerbated by the immunocompromised state. Timely diagnosis and treatment are crucial to prevent complications and improve outcomes in such cases.
References
Pan J, Fu Y, Cao Y, Feng G, Zhao J, Shi X, et al. Single-Center Retrospective Analysis of Prophylaxis and Treatment of Pneumocystis carinii Pneumonia in Patients with Renal Dysfunction After Renal Transplantation. Ann Transplant. 2020 Nov 13;25:e925126-1-e925126-8.
Wills NK, Lawrence DS, Botsile E, Tenforde MW, Jarvis JN. The prevalence of laboratory-confirmed Pneumocystis jirovecii in HIV-infected adults in Africa: A systematic review and meta-analysis. Med Mycol. 2021 Aug 1;59(8):802–12.
Khamlee P, Werarak P, Puttilerpong C. Incidence of Pneumocystis carinii pneumonia in treatment-naïve HIVinfected adult patients receiving primary Pneumocystis carinii pneumonia chemoprophylaxis with 48-week antiretroviral initiation. Thai J Pharm Sci. 2021 Jan 1;45(5):412–20.
Bateman M, Oladele R, Kolls JK. Diagnosing Pneumocystis jirovecii pneumonia: A review of current methods and novel approaches. Med Mycol. 2020 Nov 10;58(8):1015–28.
Dunphy L, Patel N, Palmer B, McKeown E. Missed opportunity to diagnose HIV with Pneumocystis carinii pneumonia as its sequela. BMJ Case Rep CP. 2020 Jun 1;13(6):e235386.
Hehsan MR. Severe Acute Respiratory Distress Syndrome with Pneumocystis Jirovecii Pneumonia in Man-To-Man Sexual Relations: A Case Report. Asian J Med Biomed. 2024 Feb 28;8(1):20–6.
Waheed Z, Islam N, Raza A. Pneumocystis Carnii Pneumonia Infection. 2023;19(01).
Grønseth S, Rogne T, Hannula R, Åsvold BO, Afset JE, Damås JK. Epidemiological and clinical characteristics of immunocompromised patients infected with Pneumocystis jirovecii in a twelve-year retrospective study from Norway. BMC Infect Dis. 2021 Jul 7;21(1):659.
Orsini J, Gawlak H, Sabayev V, Shah K, Washburn L, McCarthy K, et al. Pneumocystis jirovecii PneumoniaAssociated Acute Respiratory Distress Syndrome Complicated by Pneumomediastinum and Pneumopericardium in a Non-Human Immunodeficiency Virus-Infected Patient. J Clin Med Res. 2020 Mar;12(3):209–13.
LAMBERT J, D LUNG J, F ALANDARY S. A CASE REPORT OF PNEUMOCYSTIS JIROVECI PNEUMONIA CAUSING ARDS IN HIV/AIDS IN THE SETTING OF COVID-19 PANDEMIC. Chest. 2022 Oct;162(4):A319.
Wang HY, Li YH, Zhang SS, Jiang X, Niu XG, Qian XL, et al. Application of Extracorporeal Membrane Oxygenation in Patients With Severe Acute Respiratory Distress Syndrome Caused by Pneumocystis jirovecii Pneumonia Following Kidney Transplantation: A Case Series. Front Physiol. 2022 Jun 29;13. Available from: https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2022.902465/full
Celesia BM, Marino A, Borracino S, Arcadipane AF, Pantò G, Gussio M, et al. Successful Extracorporeal Membrane Oxygenation Treatment in an Acquired Immune Deficiency Syndrome (AIDS) Patient with Acute Respiratory Distress Syndrome (ARDS) Complicating Pneumocystis jirovecii Pneumonia: A Challenging Case. Am J Case Rep. 2020 Feb 26;21:e919570-1-e919570-5.
Wu Q, Cen F, Wang G, Huang J. Early application of awake extracorporeal membrane oxygenation in pneumocystis jirovecii pneumonia complicated with severe acute respiratory distress syndrome: a case report. Front Med. 2023 Oct 19;10. Available from: https://www.frontiersin.org/articles/10.3389/fmed.2023.1264928
Alsayed AR, Al-Dulaimi A, Alkhatib M, Al Maqbali M, Al-Najjar MAA, Al-Rshaidat MMD. A comprehensive clinical guide for Pneumocystis jirovecii pneumonia: a missing therapeutic target in HIV-uninfected patients. Expert Rev Respir Med. 2022 Nov 2;16(11–12):1167–90.
McDonald EG, Afshar A, Assiri B, Boyles T, Hsu JM, Khuong N, et al. Pneumocystis jirovecii pneumonia in people living with HIV: a review. Clin Microbiol Rev. 2024 Jan 18;37(1):e00101-22.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Licensing
Ninety Nine Publication publishes articles under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This licensing allows for any use of the work, provided the original author(s) and source are credited, thereby facilitating the free exchange and use of research for the advancement of knowledge.
Detailed Licensing Terms
Attribution (BY): Users must give appropriate credit, provide a link to the license, and indicate if changes were made. Users may do so in any reasonable manner, but not in any way that suggests the licensor endorses them or their use.
No Additional Restrictions: Users may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
