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  • Opportunistic coinfection with Pneumocystis jirovecii and Coccidioides immitis associated with idelalisib treatment in a patient with chronic lymphocytic leukaemia

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Unusual association of diseases/symptoms
Case report
Opportunistic coinfection with Pneumocystis jirovecii and Coccidioides immitis associated with idelalisib treatment in a patient with chronic lymphocytic leukaemia
  1. Lindsey M Ward1,
  2. Michael J Peluso2,3,
  3. Jehan Z Budak4,
  4. Brett M Elicker5,
  5. Peter V Chin-Hong3,
  6. Harry Lampiris3,6 and
  7. Jennifer S Mulliken3,6
  1. 1University of California San Francisco School of Medicine, San Francisco, California, USA
  2. 2Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
  3. 3Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA
  4. 4Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
  5. 5Division of Radiology, University of California, San Francisco, California, USA
  6. 6Infectious Disease Section, Medical Service, San Francisco Veterans’ Affairs Medical Center, San Francisco, California, USA
  1. Correspondence to Dr Michael J Peluso; michael.peluso{at}ucsf.edu

Abstract

We describe a case of opportunistic coinfections with Coccidioides immitis and Pneumocystis jirovecii following treatment with idelalisib, a phosphoinositide 3-kinase inhibitor, for chronic lymphocytic leukaemia. This is the first case of pulmonary coccidioidomycosis reported in association with idelalisib. We review challenges related to diagnosis of opportunistic infections in this context. This report illustrates (1) the uncommon occurrence of two opportunistic infections concurrently or in rapid succession, (2) the importance of maintaining a broad differential diagnosis in the setting of an atypical imaging finding, slow clinical response or when immunomodulatory drugs are used, and (3) the challenges associated with non-invasive serological testing in individuals with haematological malignancy on immunomodulatory therapy.

  • infections
  • TB and other respiratory infections
  • drugs: infectious diseases
  • malignant and benign haematology

http://dx.doi.org/10.1136/bcr-2019-234113

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    Footnotes

    • Contributors LMW, MJP, JZB and JSM wrote and edited the manuscript. BME created and labeled the figure. PVC and HL edited the manuscript. All authors contributed to the creation of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.