Pneumocystis jirovecii Pneumonia with a Normal Early Chest Radiography and Complicated with Drug-Induced Immune Hemolytic Anemia: A Case Report

• Published in: American Journal of Case Reports
• Main Author: Hamid N.C.; Malek K.A.; Nasir N.M.; Nasir N.M.
• Format: Article
• Language: English
• Published: International Scientific Information, Inc. 2022
• Online Access: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85135082489&doi=10.12659%2fAJCR.936278&partnerID=40&md5=75ee50ce6491e030a205a53af057df60

Patient: Male, 39-year-old Final Diagnosis: Pneumonitis Jirovecii pneumonia Symptoms: Anaemia • chills • fever • shortness of breath • tachypnea • weight loss Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Background: Case reports: Conclusions: Unusual clinical course Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection that commonly occurs in immunocompro-mised patients, especially those with HIV. Early diagnosis and prompt treatment are important because PJP is a potentially life-threatening infection. However, the diagnosis of PJP in the early stage can be challenging due to various factors. Furthermore, the early presentation of PJP, which includes normal chest radiograph and ex-amination findings along with the subacute presentation of PJP in patients with HIV, makes an early diagnosis of the disease even more challenging for doctors. In this case report, we present the case of a 39-year-old man who had normal chest X-ray findings during the initial stage of his presentation. Coupled with non-disclosure of HIV status, these led to a delay in PJP diagno-sis. The diagnosis of PJP with underlying HIV was later supported by the patient’s clinical features, initial blood investigations, and presence of high-risk sexual activity. The diagnosis was confirmed when the PJP polymerase chain reaction test from the respiratory sample was positive. He was successfully treated with oral trimethoprim-sulfamethoxazole. However, he subsequently developed rare adverse effects of drug-induced immune hemo-lytic anemia, which was diagnosed based on the presence of hemolytic anemia and recent exposure to a new drug. Trimethoprim-sulfamethoxazole was promptly discontinued, which resulted in symptom improvement. This case report aims to create awareness among primary care doctors to be vigilant of the PJP diagnosis and its nonspecific presentations as well as to the rare adverse effects of medications to treat PJP. © Am J Case Rep.