In July, 2013, a 33-year-old immunosuppressed man was referred to our hospital. HIV infection was diagnosed in 2008 and he left follow-up 2 years later. He was not taking antiretroviral drugs. 2 months before hospital admission, the patient started to have malaise, shortness of breath, cough, and diarrhoea. His respiratory status worsened in the 48 h before admission. In the ambulance, the patient was hypotensive and tachycardic, and had low blood oxygen saturation. His body temperature was 41°C. On physical examination, the patient was tachypnoeic and sweaty. On arrival at hospital, the patient was stabilised and carried directly to the critical care unit. Standard laboratory studies showed lymphopaenia (lymphocyte count 0.95xl09/L) and mild neurrophilia (neutrophils 79-8%). Serum biochemistry test results were normal. Blood gas values on room air were pH 7-52, pO2 63 ? 9 mm Hg, pCO2 30 ? 9 mm Hg, and HCO3 24.8 mmol/L. A thoracic CT scan showed diffuse, bilateral, and symmetric ground-glass attenuation. Pneumocystisjirovecii antigen was detected in sputum analysis. Trimethoprim and sulfamethoxazole IV were used with concomitant IV methylprednisolone as treatment.
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