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Summary
Concurrent Pneumocystis jirovecii (PJ) and pulmonary histoplasmosis (PHP) are rare in a single HIV individual. We present a challenging case of concomitant PJ and PHP in a young HIV individual. A 44-year-old man presented to the emergency department with progressive pulmonary symptoms. He was hypoxic with bilateral pulmonary opacities on chest radiograph. CT of the chest showed a geographical pattern of ground-glass attenuation. He started receiving intravenous antibiotics in addition to oral Bactrim for suspected PJ. He also began receiving itraconazole, given suspected PHP with recent bat-droppings exposure. HIV test was positive, though history was negative; the CD4 count was 5 cells/mm3. Later, he developed respiratory failure without clinical improvement. First bronchoalveolar lavage (BAL) failed to confirm opportunistic pathogens. Repeat BAL revealed PJ but no Histoplasma. Histoplasma antigens were positive, confirming histoplasmosis. The patient died despite aggressive treatment with intravenous Bactrim and amphotericin B.
- infections
- hiv / aids
- adult intensive care
- medical management
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Footnotes
Contributors AW has written the main manuscript of the case report and was actively involved in the literature search. SC was involved in the writing of the discussion part of the article and he also added few articles for the discussion part. MK reviewed the whole article. He was involved in the patient care. He mainly focused on the patient’s presentation and series of events occurred in intensive care unit. SJS revised the article and edited it from the English language perspective.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.