A RARE CASE OF PNEUMONIA BY CONCURRENT PNEUMOCYSTIS JIROVECI AND CYTOMEGALOVIRUS INFECTIONS

SESSION TITLE: Unusual Pneumonias SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Cytomegalovirus (CMV) is an important infectious organism in the morbidity and mortality of immunocompromised patients. CMV is a known cause of pneumoina in transplant patients, such as lung transplant recepients. Pneumocytis Jiroveci Pneumonia (PCP) is also a known risk factor for potentially life-threatening infections in immunocompromised patients. In this , we are presenting a rare case of an immunocompromised patient who had penumonia caused by a concurrent CMV and PCP infections. CASE PRESENTATION: A 53 year-old female patient with history of Rheumatoid Arthritis treated with immunomodulating medications admitted for Shortness of breath, fatigue and tiredness but no fever. COVID-19 and influenza infections (PCR) tests were both negative. At presentation, her WBC was 9900. CT with contrast of her chest showed no embolism, but multi-focal widespread groundglass opacities. Blood culture was negative, MRSA screen was negativetoo, but Fungitell test was positive (with a value of more than 500) and serum LDH test was elevated to 382. CMV quantitaive PCR was elevated to 10,000 copies. A bronchoscopy was done and CMV PCR Bronchoalveolar lavage (BAL) is detected at 650 copies/ ml. A BAL EBV PCR tests was negative. Pneumocystis Jiroveci pneumonia was detected on BAL Direct fluorescent antibody test (DFA). CMV retinitis has been ruled out by an ophthalmology exam. Patient was diagnosed with concurrent CMV and PCP pneumonia infection and her respiratory status worsened mandating a brief ICU stay. Treatment was started with Bactrim, Valganciclovir and Ganciclovir with progressive improvement. In a follow up appointment at the infectious diease clinic two months later, the patient condition improved but was still in need for supplemental oxygen through nasal canula. DISCUSSION: A concurrent CMV and PCP microorganisms lung infection is rare, but patient with underlying immunocompromise constitue a major risk factor for that. CONCLUSIONS: Patients with underlying immuncompromise conditions are at risk of many infections with grave morbidity and mortality risks. Though it is a rare to have a concurrent CMV and PCP lung infection, a patient treated with immunomodulating medications including methotrexate, prednisone and rituximab was a culprit for severe infection. Reference #1: Peghin, M., Hirsch, H. H., Len, Ó., Codina, G., Berastegui, C., Sáez, B., Solé, J., Cabral, E., Solé, A., Zurbano, F., López-Medrano, F., Román, A., & Gavaldá, J. (2016). Epidemiology and immediate indirect effects of respiratory viruses in lung transplant recipients: A 5-year prospective study. American Journal of Transplantation, 17(5), 1304–1312. https://doi.org/10.1111/ajt.14042 DISCLOSURES: No relevant relationships by MohD Ibrahim

A RARE CASE OF PNEUMONIA DUE TO CONCURRENT PNEUMOCYSTIS JIROVECI AND CYTOMEGALOVIRUS INFECTIONS

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: Cytomegalovirus is an important cause of morbidity and mortality in immunocompromised patients.CMV is an important cause of pneumoina in lung transplant patients too. Pneumocytis Jiroveci (PCP) can casue a potentially life-threatening infection in immunocompromised individuals, especially HIV patients or transplant patients. In our we are presenting a rare case of an immunocompromised patient with penumonia who was infected concurrently with CMV and PCP. CASE PRESENTATION: A 53 year-old female patient with history of Rheumatoid Arthritis treated with methotrexate, prednisone and rituximab presented to the emergency room with fatigue and tiredness but no fever. She was tested for COVID-19 and influenza infections (PCR) and both were negative. At presentation, her WBC was 9900. CT with contrast of the chest showed no embolism but multi-focal ground glass opacities. Pulmonary and infectious disease teams were consulted. Blood culture was negative, MRSA screen was negative, Fungitell was positive, LDH test was elevated to 382. CMV quantitaive PCR of 10,000 copies. CMV PCR BAL is detected at 650 copies/ ml, and EBV PCR tests was negative. Pneumocystis Jiroveci pneumonia was detected on BAL DFA. Fungitell waqs more than 500. CMV retinitis has been ruled out by ophthalmology exam. Patient was diagnosed with concurrent infections. Pt was started on Bactrim, valganciclovir PO and intravenous ganciclovir with improvement in her condition. DISCUSSION: It is rare to have a concurrent pneumonia infection caused by Pneumocytis Jiroveci and CMV except in immunocompromised patients. CONCLUSIONS: A concurrent Pneumocystis Jiroveci and CMV pneumonia is a rare infection but could occur in immunocompromised patients. DISCLOSURE: Nothing to declare.