Division of General Internal Medicine and Infectiology, Clinique St-Pierre Ottignies, Avenue Reine Fabiola, 9, 1340, Ottignies, Belgium.
Division of Clinical Biology and Cytology, Clinique St-Pierre Ottignies, Ottignies, Belgium.
Mycopathologia. 2019 Dec;184(6):787-793. doi: 10.1007/s11046-019-00397-w. Epub 2019 Nov 15.
Pneumocystis pneumonia (PCP) is a life-threatening fungal infection occurring in immunocompromised patients such as HIV-positive patients with low CD4 cell count or patients under heavy immunosuppressive therapy. We report the case of a 59-year-old male with severe diffuse cutaneous systemic sclerosis presenting with asthenia, dry cough and worsening shortness of breath for the last 15 days. Biological studies were remarkable for PTH-independent severe hypercalcemia with low 25-hydroxyvitamin D and a paradoxically elevated 1,25-dihydroxyvitamin D. Early bronchoalveolar lavage allowed for PCP diagnosis and targeted treatment. We discuss the underlying physiopathology and difficulties regarding prophylaxis and treatment.
卡氏肺孢子虫肺炎（PCP）是一种危及生命的真菌感染，发生于免疫功能低下的患者，如 HIV 阳性且 CD4 细胞计数低的患者，或接受大剂量免疫抑制治疗的患者。我们报告了一例 59 岁男性病例，患有严重弥漫性皮肤系统性硬化症，出现乏力、干咳和呼吸困难逐渐加重 15 天。生物学研究显示，甲状旁腺激素非依赖性严重高钙血症，25-羟维生素 D 水平低，1,25-二羟维生素 D 水平异常升高。早期支气管肺泡灌洗有助于诊断卡氏肺孢子虫肺炎并进行靶向治疗。我们讨论了潜在的病理生理学以及预防和治疗方面的困难。
