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Pneumocystis pneumonia with respiratory failure in a HIV-negative patient following short course of low-dose to moderate-dose prednisolone for a dermatological condition
  1. Branko Borojevic,
  2. Esther Johns,
  3. Nihal Raju and
  4. Lachlan Angus Sycamnias
  1. General Medicine, Austin Health, Heidelberg, Victoria, Australia
  1. Correspondence to Dr Branko Borojevic; borojevicbranko2{at}


A woman in her 80s was admitted with 5 days of progressive dyspnoea and hypoxic respiratory failure, in the setting of receiving a 3-week course of low-dose to moderate-dose prednisolone for a pruritic skin rash. Her medical history was not significant for major medical comorbidities or any other clear risk factors for secondary immunosuppression apart from advanced age. CT revealed widespread small-airway and parenchymal disease with ground-glass opacities consistent with atypical respiratory infection. Sputum PCR confirmed Pneumocystis jirovecii. She was diagnosed with Pneumocystis jirovecii pneumonia (PJP) in the context of her clinical presentation, radiological features and PCR result. Her HIV status was negative. The patient was treated with 4 weeks of trimethoprim–sulfamethoxazole and 3 weeks of adjunctive prednisolone. She initially required high-dependency unit support with non-invasive ventilation. In this case report, we review the literature regarding PJP in the dermatology setting.

  • Infectious diseases
  • Pneumonia (infectious disease)
  • Dermatology

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  • Contributors BB: care for the patient, inception, data collection and primary draft composition. EJ: care for the patient, primary draft and editing. NR: care for the patient, primary draft and editing. LAS: primary draft composition, data analysis and organisation, and editing.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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