Asunto(s)
Betacoronavirus/inmunología , Infecciones por Coronavirus/inmunología , Pneumocystis carinii/inmunología , Neumonía por Pneumocystis/inmunología , Neumonía Viral/inmunología , Proteínas Asociadas a Surfactante Pulmonar/química , Surfactantes Pulmonares/química , Glicoproteína de la Espiga del Coronavirus/química , Secuencia de Aminoácidos , Anticuerpos Antivirales/química , Anticuerpos Antivirales/genética , Betacoronavirus/patogenicidad , COVID-19 , Coronavirus Humano 229E/inmunología , Infecciones por Coronavirus/genética , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Coronavirus Humano OC43/inmunología , Reacciones Cruzadas , Epítopos/química , Epítopos/genética , Epítopos/inmunología , Expresión Génica , Interacciones Huésped-Patógeno/genética , Interacciones Huésped-Patógeno/inmunología , Humanos , Oligopéptidos/química , Oligopéptidos/genética , Oligopéptidos/inmunología , Pandemias , Pneumocystis carinii/patogenicidad , Neumonía por Pneumocystis/genética , Neumonía por Pneumocystis/patología , Neumonía por Pneumocystis/virología , Neumonía Viral/genética , Neumonía Viral/patología , Neumonía Viral/virología , Unión Proteica , Proteínas Asociadas a Surfactante Pulmonar/genética , Proteínas Asociadas a Surfactante Pulmonar/inmunología , Surfactantes Pulmonares/inmunología , Surfactantes Pulmonares/metabolismo , SARS-CoV-2 , Homología de Secuencia de Aminoácido , Glicoproteína de la Espiga del Coronavirus/genética , Glicoproteína de la Espiga del Coronavirus/inmunologíaRESUMEN
HISTORY AND CLINICAL FINDINGS: A 68-year-old male patient with psorias and a bullous pemphigoid as an underlying disease developed bilateral groundglass opacities on chest CT under longer-term, higher-dose immunosuppressive therapy with methylprednisolone with clinical symptoms of dry cough, progressive dyspnea and fever. DIAGNOSIS AND THERAPY: After the exclusion of COVID-19, Pneumocystis jirovecii pneumonia (PCP) was detected and a corresponding high-dose therapy with trimethoprim-sulfamethoxazole was initiated promptly. COURSE: Nonetheless, a complicated course with bacterial superinfection and pulmonary aspergillosis as well as ARDS developed. DISCUSSION AND CONCLUSION: In contrast to COVID-19, the typical course, diagnosis and therapy of Pneumocystitis jirovecii pneumonia are discussed. It is particularly emphasized that not all ground glass infiltrates in the CT chest image can be traced back to a COVID-19, even in a pandemic situation. Possible differential diagnoses should always be considered and taken into account in the diagnosis.
Asunto(s)
Pneumocystis carinii , Neumonía por Pneumocystis , Anciano , Antifúngicos/administración & dosificación , Antifúngicos/uso terapéutico , COVID-19 , Diagnóstico Diferencial , Humanos , Masculino , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/tratamiento farmacológico , Neumonía por Pneumocystis/patología , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case of a 52-year-old male patient, who presented to the emergency department for severe dyspnea and died 17 h later. The RT-PCR test performed at his admission was negative for SARS-CoV-2. Retesting of lung fragments collected during autopsy revealed a positive result for SARS-CoV-2. Histopathological examination showed preexisting lesions, due to comorbidities, as well as recent lesions: massive lung thromboses, alveolar exudate rich in foam cells, suprapleural and intra-alveolar Pneumocystisjirovecii cystic forms, and bilateral adrenal hemorrhage. Conclusion: COVID-19 and P.jirovecii coinfection should be considered, particularly in critically ill patients, and we recommend the systematic search for P. jirovecii in respiratory samples.
Asunto(s)
COVID-19/patología , Pulmón/patología , Neumonía por Pneumocystis/patología , Insuficiencia Respiratoria/patología , Trombosis/patología , Lesión Renal Aguda/complicaciones , Insuficiencia Hepática Crónica Agudizada/complicaciones , Enfermedades de las Glándulas Suprarrenales/complicaciones , Enfermedades de las Glándulas Suprarrenales/patología , Autopsia , COVID-19/complicaciones , Coinfección/patología , Exudados y Transudados , Resultado Fatal , Fibrosis , Células Espumosas/patología , Hemorragia/complicaciones , Hemorragia/patología , Humanos , Hipertensión/complicaciones , Hepatopatías Alcohólicas/complicaciones , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Neumonía por Pneumocystis/complicaciones , Arteria Pulmonar/patología , Venas Pulmonares/patología , Insuficiencia Respiratoria/etiología , SARS-CoV-2 , Trombosis/etiologíaRESUMEN
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.