Respiratory failure in pregnancy due to Pneumocystis carinii: report of a successful outcome.

BACKGROUND

The incidence of infection with the human immunodeficiency virus (HIV) is rising rapidly among women of reproductive age. Pneumocystis carinii pneumonia during pregnancy may be the first manifestation of HIV infection. If respiratory failure ensures, the outcome has been reported as almost invariably fatal.

CASE

A 31-year-old African-American woman at 28 weeks' gestation was admitted with bilateral perihilar interstitial infiltrates. Laboratory evaluation revealed hypoxemia and an elevated serum lactic dehydrogenase level. Although she denied risk factors for HIV infection, she was treated immediately for P carinii infection with trimethoprim-sulfamethoxazole and methylprednisolone. Her respiratory status deteriorated and she required intubation. Bronchoscopy confirmed the diagnosis, and CD4 lymphocyte depletion confirmed immunosuppression. The patient responded to treatment and recovered completely.

CONCLUSION

A high index of suspicion must be maintained for the diagnosis of P carinii and previously unsuspected HIV infection during pregnancy. The early manifestations may be subtle and progress over weeks until respiratory failure rapidly ensues. With timely diagnosis and management, the outcome of P carinii pneumonia in pregnancy can be successful.