ABSTRACT
Although Pneumocystis jiroveci pneumonia (PCP) is a frequent manifestation of acquired immune deficiency syndrome (AIDS), the granulomatous form is uncommon. Here, we present an unusual case of granulomatous PCP consequent to immune reconstitution inflammatory syndrome (IRIS) after highly active antiretroviral therapy. A 36-year-old woman with human immunodeficiency virus (HIV) presented with cough and dyspnea that were attributed to typical PCP associated with AIDS. She was successfully treated with antibiotic, steroid, and antiretroviral therapies. After six months, however, she presented with consolidating lung lesions caused by bronchial obstruction from PCP granulomatous disease. Although antibiotics were ineffective, the effectiveness of steroid therapy suggested a diagnosis of granulomatous IRIS caused by persistent PCP antigens. Physicians should strongly suspect PCP in HIV-positive patients with nodular lung lesions and must remain aware that these lesions, if immune in origin, might not respond to antimicrobial therapy.
Subject(s)
Antiretroviral Therapy, Highly Active/adverse effects , Granuloma, Respiratory Tract/diagnosis , HIV Infections/drug therapy , Immune Reconstitution Inflammatory Syndrome/complications , Lung/diagnostic imaging , Pneumocystis carinii/isolation & purification , Pneumonia, Pneumocystis/diagnosis , Adult , Anti-Infective Agents, Urinary/therapeutic use , Bronchoscopy , Female , Granuloma, Respiratory Tract/complications , HIV Infections/complications , HIV Infections/microbiology , Humans , Immune Reconstitution Inflammatory Syndrome/drug therapy , Immunocompromised Host , Pneumocystis carinii/immunology , Pneumonia, Pneumocystis/drug therapy , Prednisone/therapeutic use , Tomography, X-Ray Computed , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug CombinationABSTRACT
Sepsis is a clinical syndrome that results from the dysregulated inflammatory response to infection that leads to organ dysfunction. The resulting losses to society in terms of financial burden, morbidity, and mortality are enormous. We provide a review of sepsis, its underlying pathophysiology, and guidance for diagnosis and management of this common disease. Current established treatments include appropriate antimicrobial agents to target the underlying infection, optimization of intravascular volume to improve stroke volume, vasopressors to counteract vasoplegic shock, and high-quality supportive care. Appropriate implementation of established treatments combined with novel therapeutic approaches promises to continue to decrease the impact of this disease.
