Cavitary lung lesions caused by Pneumocystis jirovecii in a patient with myelofibrosis on ruxolitinib.
BMJ Case Rep
; 17(8)2024 Aug 30.
Article
in En
| MEDLINE
| ID: mdl-39214573
ABSTRACT
We report a rare case of a patient with Janus kinase 2-positive myelofibrosis on ruxolitinib, presenting with indolent pneumonia and cavitary lung lesions. Initial transthoracic biopsy was non-specific, but thoracoscopic biopsy revealed necrotising granulomatous disease caused by Pneumocystis jirovecii pneumonia (PJP). The patient, initially treated with trimethoprim-sulfamethoxazole, was switched to atovaquone due to gastrointestinal intolerance. Given the patient's immunosuppression and extensive cavitary lesions, an extended course of atovaquone was administered, guided by serial imaging, resulting in clinical and radiological improvement. Unfortunately, the patient later passed away from a severe SARS-CoV-2 infection before complete radiographic resolution was observed. This case highlights the importance of recognising atypical PJP presentations causing granulomatous disease in immunosuppressed patients. While rare, documenting such cases may improve diagnosis using less invasive methods and help determine optimal treatment durations for resolution of these atypical infections.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pneumonia, Pneumocystis
/
Pyrazoles
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Pyrimidines
/
Pneumocystis carinii
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Primary Myelofibrosis
/
Nitriles
Limits:
Aged
/
Humans
/
Male
Language:
En
Journal:
BMJ Case Rep
Year:
2024
Document type:
Article
Affiliation country:
United States
Country of publication:
United kingdom