Extrapulmonary pneumocystosis in an antiretroviral therapy-naïve, HIV-positive patient

Int J Infect Dis. 2022 Jul:120:65-67. doi: 10.1016/j.ijid.2022.03.058. Epub 2022 Apr 6.

Abstract

Pneumocystis jirovecii is a common opportunistic fungal pathogen that commonly affects immunocompromised individuals and can cause P. jirovecii pneumonia. Extrapulmonary P. jirovecii infections are extremely rare. Herein, we present a case of an HIV-positive, antiretroviral therapy-naïve patient who had extrapulmonary pneumocystosis (EPC). He presented with complaints of decreased appetite, abdominal fullness, and weight loss. Computed tomography (CT) revealed multiple low-attenuation masses in the spleen, liver, and both adrenal glands but no pulmonary involvement. A core-needle biopsy of a splenic lesion confirmed the diagnosis of EPC. The patient was initiated on intravenous trimethoprim-sulfamethoxazole (TMP-SMX) and CT-guided percutaneous catheter drainage of the splenic lesion was performed. Intravenous TMP-SMX therapy was completed in 3 weeks and intravenous pentamidine (250 mg daily) therapy was commenced. Pentamidine was completed after 3 weeks, and antiretroviral treatment (ART) was initiated with dolutegravir 50 mg and Descovy HT (emtricitabine [200 mg] and tenofovir alafenamide fumarate [25 mg]). After starting ART, the patient's clinical condition improved, and the abscesses gradually reduced. TMP-SMX is commonly used to treat EPC; however, there is no standard method of treatment. ART may become the key to EPC treatment in individuals with HIV infection.

Keywords: Pneumocystis jirovecii; Pneumocystis jirovecii pneumonia; aerosolized pentamidine; antiretroviral therapy; extrapulmonary pneumocytosis; human immunodeficiency virus-1.

Publication types

  • Case Reports

MeSH terms

  • HIV Infections* / complications
  • HIV Infections* / drug therapy
  • HIV Seropositivity* / complications
  • Humans
  • Male
  • Pentamidine
  • Pneumocystis carinii*
  • Pneumonia, Pneumocystis* / diagnosis
  • Pneumonia, Pneumocystis* / drug therapy
  • Pneumonia, Pneumocystis* / etiology
  • Retrospective Studies
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use

Substances

  • Pentamidine
  • Trimethoprim, Sulfamethoxazole Drug Combination