Extrapulmonary pneumocystosis in an antiretroviral therapy-naïve, HIV-positive patient. (July 2022)

• Record Type: Journal Article
• Authors: Hasegawa, Makoto; Ito, Yuji; Osugi, Yasuhiro; Hashimoto, Masahiro; Hashimoto, Nanako; Yano, Kunio
• Is Part Of: International journal of infectious diseases. Volume 120(2022)
• Page Start: 65
• Page End: 67
• Publication Date: 2022-07
• Subjects: Pneumocystis jirovecii -- human immunodeficiency virus-1 -- Pneumocystis jirovecii pneumonia -- antiretroviral therapy -- extrapulmonary pneumocytosis -- aerosolized pentamidine; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2022.03.058
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: We present the case of a HIV-positive, antiretroviral therapy–naïve patient with extrapulmonary pneumocystosis. The splenic mass reduced in size with drainage, and the other masses resisted interventions. Early antiretroviral therapy served as a successful treatment strategy. Abstract: Pneumocystis jirovecii is a common opportunistic fungal pathogen that commonly affects immunocompromised individuals and can cause P. jirovecii pneumonia. Extrapulmonary P. jirovecii infections are extremely rare. Herein, we present a case of an HIV-positive, antiretroviral therapy–naïve patient who had extrapulmonary pneumocystosis (EPC). He presented with complaints of decreased appetite, abdominal fullness, and weight loss. Computed tomography (CT) revealed multiple low-attenuation masses in the spleen, liver, and both adrenal glands but no pulmonary involvement. A core-needle biopsy of a splenic lesion confirmed the diagnosis of EPC. The patient was initiated on intravenous trimethoprim-sulfamethoxazole (TMP-SMX) and CT–guided percutaneous catheter drainage of the splenic lesion was performed. Intravenous TMP-SMX therapy was completed in 3 weeks and intravenous pentamidine (250 mg daily) therapy was commenced. Pentamidine was completed after 3 weeks, and antiretroviral treatment (ART) was initiated with dolutegravir 50 mg and Descovy HT (emtricitabine [200 mg] and tenofovir alafenamide fumarate [25 mg]). After starting ART, the patient's clinical condition improved, and the abscesses gradually reduced. TMP-SMX is commonly used to treat EPC; however, there is no standard method of treatment. ART may become the key to EPC treatment in individuals with HIV infection.