Akute respiratorische Dekompensation unter Steroidtherapie bei Verdacht auf allergische Alveolitis

摘要

A 39-year-old patient presented with progressive dyspnea. Computed tomography findings were bilateral pulmonary infiltrates as ground glass opacities. The bronchoalveolar lavage revealed a diminished ratio of CD4/CD8 cells and on the assumption of a hypersensitivity pneumonitis a high-dose corticosteroid therapy was started. The radiological findings were noticeably progressive and the patient suffered from respiratory insufficiency. As a differential diagnosis Pneumocystis jiroveci pneumonia (PcP) was taken into consideration, human immunodeficiency virus (HIV) disease was diagnosed and after detection of pneumocysts the corresponding anti-infection therapy was started.