A previously healthy 28-year-old female presented in gestational week (GW) 25 + 0 with dyspnea, cough, and subfebrile temperatures. Radiography revealed bilateral interstitial infiltrates (figure). Initial empirical antibiotic therapy failed to achieve an improvement. Oral candidiasis that was additionally noticed in combination with the radiological infiltrates was suggestive of immune suppression. The further diagnostic work-up yielded evidence of Pneumocystis jirovecii in the bronchoalveolar lavage, as well as a positive HIV test (CD4 cells 31/###µL). The patient received intravenous co-trimoxazole and oral fluconazole. Antiretroviral treatment with emtricitabine/tenofovir and raltegravir was promptly initiated. In GW 31 + 2, premature rupture of membranes and cervical contractions occurred, necessitating emergency cesarean section. The infant subsequently received post-exposure prophylaxis and is currently HIV-negative. Pneumocystis pneumonia is one of the most frequent opportunistic infections in the setting of HIV in Germany. In order to prevent HIV-related complications and avoid vertical transmission to the infant, free HIV testing should be offered during pregnancy, in line with the maternity guidelines.
Figure.
Translated from the original German by Christine Rye.
Cite this as: Fritzsche C, Löbermann M, Bolz M: Interstitial pneumonia during pregnancy.
Footnotes
Conflict of interest statement:
PD Dr. Fritzsche has received reimbursement of conference attendance fees as well as travel and accommodation expenses from Gilead. He received payment for authorship from Elsevier and mhp Verlag. PD Dr. Löbermann has received reimbursement of conference attendance fees as well as travel and accommodation expenses from Astellas. He received payment for preparing continuing medical education events from Gilead and Abbvie. Dr. Bolz states that no conflict of interest exists.