Pneumocystis jirovecii pneumonia in a patient with HIV infection: complex diagnosis using Giemsa-stained bronchoalveolar lavage fluid

摘要

A 54-year-old Brazilian man presented to the emergency department with cough, chest pain, high fever, and dyspnea. He had no history of sexually transmitted infections. A thoracic computed tomography scan showed ground-glass opacification areas and mediastinal lymphadenopathy. Laboratory tests revealed the following abnormalities: absolute monocyte count, 80 cells/mm3 ; partial pressure of oxygen, 55.3 mmHg; and C-reactive protein,304.3 mg/L. Blood tests for cytomegalovirus, Chlamydia pneumoniae, Legionella pneumophila, and Mycoplasma pneumoniae and a sputum analysis for Mycobacterium tuberculosis were negative. Microscopic examination of Giemsastained bronchoalveolar lavage fluid (BALF) showed cysts of the atypical fungus Pneumocystis jirovecii (Figure 1), the etiological agent of pneumocystis pneumonia (PCP). Additional investigations revealed human immunodeficiency virus (HIV) infection, low CD4+ T-cell count (128 cells/mm3 ), and increased lactate dehydrogenase levels. Antiretroviral therapy (ART) and trimethoprim/sulfamethoxazole (14 days) treatment were established. The patient was discharged 30 days post-admission.