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CASE REPORT
HIV-related Pneumocystis jirovecii pneumonia managed with caspofungin and veno-venous extracorporeal membrane oxygenation rescue therapy
  1. Nathaniel Lee1,
  2. David Lawrence2,
  3. Brijesh Patel1,3,
  4. Stephane Ledot1
  1. 1Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Anaesthesia and Critical Care, London, UK
  2. 2The Lawson Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  3. 3Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
  1. Correspondence to Dr Brijesh Patel, brijesh.patel{at}imperial.ac.uk

Summary

Patients with pneumocystis pneumonia have a risk of progressing to acute respiratory failure necessitating admission to intensive care. The case described is of a patient with a newly diagnosed HIV infection presenting with pneumocystis pneumonia. Despite initiating the appropriate pharmacological treatment the patient’s clinical condition deteriorated, and required both rescue pharmacological therapy with echinocandins as well as respiratory support with extracorporeal membrane oxygenation therapy. The patient recovered well on ventilator and circulatory support despite a long weaning process complicated by sequelae common to pneumocystis pneumonia. Following initialisation of antiretroviral therapy and step-down from an intensive care setting, the patient required further prolonged hospital stay for rehabilitation and mental health support before being discharged. This case reviews the novel pharmacological therapies and respiratory support strategies used in cases of pneumocystis pneumonia, including the clinical and psychological sequelae that may follow.

  • HIV/AIDS
  • adult intensive care
  • mechanical ventilation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors NL conceptualised the project, initiated and completed data collection, drafted initial and final versions of manuscripts, and provided final input to accepted version. DL and BP contributed patient data and provided input to the initial and final manuscripts. SL provided patient data, acquired patient consent for publication, and contributed to the initial and final manuscripts.

  • Competing interests None declared.

  • Patient consent Obtained.

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

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