A 56-year-old female patient with carcinoma of the pancreas on chemotherapy with gemcitabine, presented with a short history of fever, cough, and breathlessness. She was found to be hypoxic on admission and there were diffuse ground glass opacities with peripheral and basal sparing on high-resolution computed tomography (HRCT). Serum lactate dehydrogenase (LDH) and serum β-D-glucan (BDG) were high, and gomori methamine silver (GMS) staining from the throat gargle specimen showed typical cysts of Pneumocystis pneumonia (PCP). Therefore, she received treatment with trimethoprim/sulfamethoxazole (TMP/SMX) and steroids at first, which was later changed to primaquine + clindamycin in view of TMP/SMX-related toxicity. However, despite all measures, she succumbed to the illness. This case highlights the importance of PCP in immunocompromised hosts other than human immunodeficiency virus (HIV), the role of serum markers like LDH and BDG,6 and the use of throat gargle samples5 for microscopy and polymerase chain reaction (PCR). An unmet clinical need is a guide to prophylaxis, therapy, and adjuvant steroids in non-HIV patients.9
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Chakraborty S, Soman R, Joe G. P171 Pneumocystis Jirovecii Pneumonia in non-HIV immunosuppressed patients: a case series. Med Mycol 2022;60(Suppl 1):myac072P171. DOI: 10.1093/mmy/myac072.P171
Rudramurthy SM, Sharma M, Sharma M, et al. Reliable differentiation of Pneumocystis pneumonia from Pneumocystis colonisation by quantification of Major Surface Glycoprotein gene using real-time polymerase chain reaction. Mycoses 2018;61(2):96–103. DOI: 10.1111/myc.12708
