A diagnostic challenge in COVID-19 pandemic: PCP or COVID-19

ABSTRACT

This case report describes the clinical course and management of a 67-year gentleman presented with shortness of breath, fever and cough. History is significant for diabetes and hypertension. Baseline imaging and routine blood tests were consistent with respiratory tract infection. The patient clinically deteriorated, inflammatory markers increased by and the ABG showed type 1 respiratory failure. He was admitted to the ICU, and due to severe hypoxemia, he was intubated and mechanically ventilated. Treatment with broad-spectrum intravenous (IV) antibiotics was initiated but no clinical or radiological improvement was observed. Chest CT scan showed bilateral opacity/unification of the mid-inferior lungs in patch and interstitial pneumonia (Figs 1A and B). On clinical suspicion and repeated negative COVID-19 swabs, negative blood and urine cultures, treatment with PCP was initiated. There was excellent clinical improvement. Patient was extubated and then weaned off oxygen. His HIV status was negative, but his sputum and CRP showed PCP.