ABSTRACT
While clinical environments are highly focused on COVID-19, reports of missed or delayed treatment for conditions that imitate COVID-19, such as pneumonia caused by the fungus Pneumocystis jirovecii, are emerging. Given the uncertain spectrum of COVID-19 presentations and variable sensitivity of laboratory tests for SARS-CoV-2, there is a risk that, without a high index of suspicion, alternative aetiologies may be overlooked while pursuing a diagnosis of COVID-19. The British HIV Association has been calling for the inclusion of HIV testing in all patients admitted to hospital with suspected COVID-19. In this article we reflect on the importance of including HIV testing to prevent avoidable morbidity and mortality in our patients.
Subject(s)
AIDS-Related Opportunistic Infections , Pneumonia, Pneumocystis , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/pathology , AIDS-Related Opportunistic Infections/physiopathology , AIDS-Related Opportunistic Infections/therapy , COVID-19 , Coronavirus Infections , Diagnosis, Differential , Fatal Outcome , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Pandemics , Pneumocystis carinii , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/pathology , Pneumonia, Pneumocystis/physiopathology , Pneumonia, Pneumocystis/therapy , Pneumonia, ViralABSTRACT
We present the case of an oncology patient admitted to our hospital during the current COVID-19 pandemic with clinical and radiological features strongly suggestive of interstitial pneumonia. Multiple laboratory tests were negative for SARS-CoV-2 (polymerase chain reaction testing of nasopharyngeal swabs, and of induced sputum and stool samples, investigation of serum immunoglobulins G and M). In the setting of an immunocompromised status due to recent chemotherapy cycles for lung adenocarcinoma and prolonged corticosteroid therapy (due to frequent exacerbations of chronic obstructive pulmonary disease in recent months), we actively searched for the pathological agent and found it to be Pneumocystis jirovecii. The patient started specific antibiotic treatment but finally had a negative outcome due to the progression of the lung adenocarcinoma. The importance of differential diagnostics in clinical practice should be a given, especially during times of pandemic. The novel coronavirus infection introduced new guidelines for and approaches to the investigation of immunocompromised patients, so it is especially important not to forget the basis of differential diagnosis, to and adopt a thorough approach when assessing these complex patients. We want to stress the importance of thorough investigation to avoid misdiagnosis of atypical pathogens in the current setting of SARS-CoV-2 pandemic.