The following is an interesting case which presented to me several weeks ago…
~50 y F with hx HIV, not taking antiretrovirals presents with cough, SOB for weeks without improvement on amoxicillin. Now has O2 Sat 86% on room air with the following CXR.
Take home bullet points
- Be suspicious of PC pneumonia in all immunocompromised patients
- Look for diffuse interstitial pneumonia or “Bat Wing” pattern on chest XR
- TMP/SMX is the antibiotic therapy of choice, If patient is unable to take TMP/SMX: pentamidine, atovaquone, and primaquine plus clindamycin are alternative regimens to consider
- LDH: Levels greater than 450 are strongly predictive of PCP
- A-a oxygen gradient: >35 mmHg while breathing room air is an indication for adjunctive prednisone therapy
- Partial Pressure O2: <70 mmHg while breathing RA is and indication for adjunctive prednisone therapy
- Consensus statement on the use of corticosteroids as adjunctive therapy for pneumocystis pneumonia in the acquired immunodeficiency syndrome. The National Institutes of Health-University of California Expert Panel for Corticosteroids as Adjunctive Therapy for Pneumocystis Pneumonia.
- Serum lactate dehydrogenase levels and Pneumocystis carinii pneumonia. Diagnostic and prognostic significance.
- Pneumocystis Carinii Pneumonia
Max and Steve