To the Editor,
A 24 years old male patient with Acquired Immunodeficiency Syndrome (AIDS) as an underlying disease complained dyspnea on exertion, cough with whitish sputum and fever since one week ago. The feature of his chest radiography was interstitial infiltration over bilateral lungs. COVID-19 infection was the impression at first. However, the Reverse Transcriptase - Polymerase Chain Reaction (RT-PCR) result excluded the diagnosis of COVID-19. According to the computed tomography (Fig. 1 ), the patient was diagnosed as Pneumocystis jerovecii pneumonia (referred from Pneumocystitis carinii pneumonia, PCP).1 Endotracheal tube intubation with mechanical ventilator supporter was performed due to respiratory failure after admission. No other isolation or sterilization were required. The patient was discharged two weeks later without notable complication after medical treatment.
Fig. 1.
Computed tomography on July 29, 2020.
Several cases of invasive fungal diseases in patients with COVID-19 have been reported, mostly due to Aspergillus spp., with anecdotic reports of Pneumocystis jirovecii pneumonia (PJP) as co-infections in immunocompromised patients.2
Pneumocystis jerovecii pneumonia (PJP) is one kind of atypical pneumonia, which has different course than lobar or bronchopneumonia. In opposite to the usual bacteriologic pneumonia in “atypical pneumonia”, there are only seen slight palpatory and auscultatory findings. In spite of high fever, there are no tachycardia and leucocytosis. “Atypical pneumoniae” were caused by mycoplasmae, rickettsiae (Q-fever), chlamydiae (ornithosis), viruses (influenca, adenoviruses, cytomegalia, measles, varicellae) or protozoa (pneumocystitis carinii).3 Pneumocystis jirovecii pneumonia (PJP) is an opportunistic fungal pathogen that can cause severe pneumonia in immunocompromised hosts. Risk factors for Pneumocystis jirovecii pneumonia (PJP) include HIV, organ transplant, malignancy, certain inflammatory or rheumatologic conditions, and associated therapies and conditions that result in cell-mediated immune deficiency. Clinical signs of PJP are nonspecific and definitive diagnosis requires direct detection of the organism in lower respiratory secretions or tissue.4 In a cohort study of 168 patients, all of the patients were HIV-seropositive males. The most common chest radiograph findings were bronchial-wall thickening, nodules, Kerley B lines, and pleural effusions. The presence of granular opacities or cystic spaces usually indicated concomitant Pneumocystitis carinii pneumonia (p < 0.001).5
It should be kept in mind that even during the pandemic of COVID-19, not all the lung infiltration in chest images could be signs of SARS-CoV2 infection. We should always consider possible differential diagnosis.
Declaration of competing interest
The author have no conflicts of interest relevant to this article.
References
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