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

International Journal of Infectious Diseases

Yuji Ito¹  Makoto Hasegawa²  Yasuhiro Osugi³  Masahiro Hashimoto⁴  Nanako Hashimoto⁵  Kunio Yano⁵ 

[1] Corresponding author: Makoto Hasegawa, Department of General Internal Medicine, Fujita Helth University Okazaki Medical Center, 1 Harisaki, Okazaki-city, Aichi-prefecture, Japan, Phone No: [phone].;Department of General Internal Medicine, Fujita Health University Okazaki Medical Center, Japan;Department of General Internal Medicine, Tyutoen General Medical Center, 1-1 Syobugaike, Kakegawa-city, Shizuoka prefecture, Japan;Department of General Medicine, Toyota Regional Medical Center, 3-30 Nishiyamacho, Toyota-city, Aichi-prefecture, Japan;Department of Radiology, Tyutoen General Medical Center, 1-1 Syobugaike, Kakegawa-city, Shizuoka prefecture, Japan;

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

DOI  :  

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown