Hussain Hussain, Paidas Michael, Fadel Aya, Garcia Efrain, Saadoon Zahraa, Mendez Luis, Jayakumar Arumugam
Larkin Community Hospital, Department of Internal Medicine, Miami, FL, USA.
University of Miami Miller School of Medicine Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Discoveries (Craiova). 2022 Dec 31;10(4):e161. doi: 10.15190/d.2022.20. eCollection 2022 Oct-Dec.
We present a case of disseminated Pneumocystis jirovecii pneumonia in a patient with a medical history of glioblastoma multiforme associated with acute deep-vein thrombosis. The patient presented to the emergency department with clinical features of pulmonary infection, and the chest images showed pneumonia. Antibiotics were initiated (azithromycin, cefepime, and vancomycin) and the patient was transferred to the ward for further management, where the condition of the patient continued to worsen over the second day. The patient developed bilateral lower extremity swelling and the doppler ultrasound revealed bilateral lower extremity acute deep vein thrombosis. Laboratory results showed pancytopenia and transaminitis. However, a repeated chest X-ray showed ground-glass changes and interstitial infiltrates, suggestive of atypical infection. We indeed identified D-glucan which hints to a disseminated form of Pneumocystis jirovecii pneumonia infection in this patient. We further confirmed the Pneumocystis jirovecii pneumonia by polymerase chain reaction test from the fluid obtained via bronchoalveolar lavage. We, therefore, initiated intravenous trimethoprim/ sulfamethoxazole treatment with an anticoagulant, and the patient's condition improved. Our findings strongly suggest a possible link between Pneumocystis jirovecii pneumonia infection and thrombogenesis, with impact in medical practice.
我们报告一例播散性耶氏肺孢子菌肺炎病例，患者有多形性胶质母细胞瘤病史并伴有急性深静脉血栓形成。患者因肺部感染的临床特征就诊于急诊科，胸部影像显示为肺炎。开始使用抗生素（阿奇霉素、头孢吡肟和万古霉素）治疗，患者被转至病房进一步治疗，然而在第二天患者病情持续恶化。患者出现双下肢肿胀，多普勒超声显示双下肢急性深静脉血栓形成。实验室检查结果显示全血细胞减少和转氨酶升高。但是，重复胸部X线检查显示磨玻璃样改变和间质浸润，提示非典型感染。我们确实检测到D-葡聚糖，这提示该患者存在播散性耶氏肺孢子菌肺炎感染。通过支气管肺泡灌洗获取的液体进行聚合酶链反应检测，我们进一步确诊了耶氏肺孢子菌肺炎。因此，我们开始静脉给予甲氧苄啶/磺胺甲恶唑治疗并加用抗凝剂，患者病情好转。我们的研究结果强烈提示耶氏肺孢子菌肺炎感染与血栓形成之间可能存在联系，这对医学实践具有重要意义。
