RT Journal Article
SR Electronic
T1 Opportunistic coinfection with <em>Pneumocystis jirovecii</em> and <em>Coccidioides immitis</em> associated with idelalisib treatment in a patient with chronic lymphocytic leukaemia
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e234113
DO 10.1136/bcr-2019-234113
VO 13
IS 4
A1 Lindsey M Ward
A1 Michael J Peluso
A1 Jehan Z Budak
A1 Brett M Elicker
A1 Peter V Chin-Hong
A1 Harry Lampiris
A1 Jennifer S Mulliken
YR 2020
UL http://casereports.bmj.com/content/13/4/e234113.abstract
AB 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.