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Pneumocystis jirovecii pneumonia in newly diagnosed treatment-naïve chronic lymphocytic leukaemia
  1. Elspeth Springsted1,
  2. Badri Giri2 and
  3. Venkateswara Kollipara3
  1. 1Internal Medicine Department, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
  2. 2Pulmonary and Critical care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
  3. 3Pulmonary and Critical Care Medicine, Salem VA Medical Center, Salem, Virginia, USA
  1. Correspondence to Dr Venkateswara Kollipara; kumarkollipara.0308{at}gmail.com

Abstract

A 78-year-old man with newly diagnosed treatment-naïve chronic lymphocytic leukaemia (CLL) was referred to a pulmonary clinic for 1 month of dry cough and dyspnoea on exertion. Further workup with CT of the chest showed patchy ground-glass opacities predominantly on the right side. The patient was started on empiric antibiotic for presumed community-acquired pneumonia but did not have any improvement in his symptoms and eventually required supplemental oxygen. Bronchoscopy with bronchoalveolar lavage from the right middle lobe showed Pneumocystis jirovecii cysts on Grocott methenamine silver stains. The patient was HIV negative. He was placed on P. jirovecii pneumonia (PJP) treatment with clindamycin and primaquine due to history of significant allergy to sulfa drugs. The patient’s symptoms completely resolved after a 21-day course of treatment and no longer needed supplemental oxygen. This case highlights the importance of keeping PJP infection in differential diagnosis in both treated and untreated patients with CLL with dyspnoea and pulmonary infiltrates.

  • pneumonia (respiratory medicine)
  • cancer - see oncology
  • respiratory medicine

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Footnotes

  • Twitter @Venkat Kollipara

  • Contributors VK was involved in management of the patient and writing the manuscript. ES and BG were involved in manuscript writing and literature review. Our manuscript is not elsewhere accepted or pending for publication.

  • 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.

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

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