Pneumocystis jirovecii Pneumonia Mimicking COVID-19 Pneumonia In A Patient With Newly Diagnosed Advanced HIV Disease
DOI:
https://doi.org/10.33102/uij.vol33no1.299Keywords:
COVID-19, HIV, cryptococcal meningitis, Pneumocystis jirovecii, pneumoniaAbstract
During the pandemic, diagnosis of COVID-19 infection must be excluded in patients presenting with respiratory features, especially in the area where the incidence was high. This case report highlights a man who came with respiratory infection symptoms and the chest radiograph suspicious of COVID-19 pneumonia; however, his swab test for RT-PCR was negative for COVID-19. Later he was found to have a positive anti-HIV antibody and developed advanced HIV infection by multiple opportunistic infections. A 45-year-old man presented with chronic cough and dyspnea for three months which worsened five days before the presentation. It was associated with diarrhoea, dysphagia, weight loss, left lower limb weakness, with bowel and urinary incontinence. Chest auscultation revealed generalized crepitations. The first chest radiograph showed bilateral reticular opacities extending to the lung peripheries when the suspected diagnosis of COVID-19 pneumonia was made. The nasopharynx swab for RT-PCR for COVID-19 was negative, and the sputum was positive for Pneumocystis jirovecii. The contrast-enhanced CT (CECT) brain revealed changes consistent with brain abscess. The cerebrospinal fluid (CSF) examination was consistent with cryptococcal infection. He was initially treated in the Severe Acute Respiratory Infection (SARI) ward because of the initial impression of COVID-19. He was tested positive for Human Immunodeficiency Virus (HIV) rapid test and PCR, RPR and TPHA for syphilis. He was diagnosed with Pneumocystis jirovecii pneumonia, cryptococcal meningitis, brain abscess, oral and oesophageal candidiasis and syphilis. He was treated with co-trimoxazole, Amphotericin B, flucytosine, fluconazole, penicillin G and Nystatin. He initially improved upon treatment but later succumbed to his illnesses. Given the current situation of COVID-19, any patient with acute respiratory symptoms must be tested to rule out COVID-19 pneumonia. However, in a newly diagnosed advanced HIV patient presented with respiratory infection symptoms and extrapulmonary symptoms, opportunistic infections should be excluded along with COVID-19.
Downloads
References
Alanio, A., Dellière, S., Fodil, S., Bretagne, S., & Mégarbane, B. (2020). Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19. The Lancet Respiratory Medicine, 8(6), e48–e49. https://doi.org/10.1016/s2213-2600(20)30237-x
Alanio, A., Dellière, S., Voicu, S., Bretagne, S., & Mégarbane, B. (2020). The presence of Pneumocystis jirovecii in critically ill patients with COVID-19. Journal of Infection, 1–2. https://doi.org/10.1016/j.jinf.2020.10.034
Bhat, P., Noval, M., Doub, J. B., & Heil, E. (2020). Concurrent COVID-19 and Pneumocystis jirovecii pneumonia in a severely immunocompromised 25-year-old patient. International Journal of Infectious Diseases, 99, 119–121. https://doi.org/10.1016/j.ijid.2020.07.061
Böger, B., Fachi, M. M., Vilhena, R. O., Cobre, A. F., Tonin, F. S., & Pontarolo, R. (2021). Systematic review with meta-analysis of the accuracy of diagnostic tests for COVID-19. American Journal of Infection Control, 49(1), 21–29. https://doi.org/10.1016/j.ajic.2020.07.011
Carpenter, C. R., Mudd, P. A., West, C. P., Wilber, E., & Wilber, S. T. (2020). Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases. Academic Emergency Medicine, 27(8), 653–670. https://doi.org/10.1111/acem.14048
Centers for Disease Control and Prevention. (2021, February 16). People with Certain Medical Conditions. Retrieved February 21, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html#immunocompromised-state
Cohen, P. A., Hall, L. E., John, J. N., & Rapoport, A. B. (2020, June). The early natural history of SARS-CoV-2 infection: clinical observations from an urban, ambulatory COVID-19 clinic. In Mayo Clinic Proceedings (Vol. 95, No. 6, pp. 1124-1126). Elsevier.
Coleman, H., Snell, L. B., Simons, R., Douthwaite, S. T., & Lee, M. J. (2020). Coronavirus disease 2019 and Pneumocystis jirovecii pneumonia: a diagnostic dilemma in HIV. AIDS, 34(8), 1258–1260. https://doi.org/10.1097/qad.0000000000002571
Duzgun, S. A., Durhan, G., Demirkazik, F. B., Akpinar, M. G., & Ariyurek, O. M. (2020). COVID-19 pneumonia: the great radiological mimicker. Insights into Imaging, 11(1), 1–15. https://doi.org/10.1186/s13244-020-00933-z
Frater, J. L., Zini, G., d’Onofrio, G., & Rogers, H. J. (2020). COVID‐19 and the clinical hematology laboratory. International Journal of Laboratory Hematology, 42(S1), 11–18. https://doi.org/10.1111/ijlh.13229
Guan, W.-, Ni, Z.-, Hu, Y., Liang, W.-, Ou, C.-, He, J.-, … Zhong, N.-. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine, 382(18), 1708–1720. https://doi.org/10.1056/nejmoa2002032
Hanfi, S. H., Lalani, T. K., Saghir, A., McIntosh, L. J., Lo, H. S., & Kotecha, H. M. (2020). COVID-19 and its Mimics. Journal of Thoracic Imaging, 36(1), W1–W10. https://doi.org/10.1097/rti.0000000000000554
Jha, A., Lohani, B., & Ghimire, R. K. (2020). Current Imaging Trends in COVID-19 Pneumonia. Journal of Nepal Medical Association, 58(226), 444–446. https://doi.org/10.31729/jnma.4992
Jiang, H., Zhou, Y., & Tang, W. (2020). Maintaining HIV care during the COVID-19 pandemic. The Lancet HIV, 7(5), e308–e309. https://doi.org/10.1016/s2352-3018(20)30105-3
Kanne, J. P., Yandow, D. R., & Meyer, C. A. (2012). Pneumocystis jiroveci Pneumonia: High-Resolution CT Findings in Patients With and Without HIV Infection. American Journal of Roentgenology, 198(6), W555–W561. https://doi.org/10.2214/ajr.11.7329
Kelly, S., Waters, L., Cevik, M., Collins, S., Lewis, J., Wu, M.-S., … Geretti, A. M. (2020). Pneumocystis pneumonia, a COVID-19 mimic, reminds us of the importance of HIV testing in COVID-19. Clinical Medicine, 20(6), 590–592. https://doi.org/10.7861/clinmed.2020-0565
Khatami, F., Saatchi, M., Zadeh, S. S. T., Aghamir, Z. S., Shabestari, A. N., Reis, L. O., & Aghamir, S. M. K. (2020). A meta-analysis of accuracy and sensitivity of chest CT and RT-PCR in COVID-19 diagnosis. Scientific Reports, 10(1), 1–12. https://doi.org/10.1038/s41598-020-80061-2
Lai, C.C., Ko, W.C., Lee, P.I., Jean, S.-S., & Hsueh, P.-R. (2020). Extra-respiratory manifestations of COVID-19. International Journal of Antimicrobial Agents, 56(2), 106024. https://doi.org/10.1016/j.ijantimicag.2020.106024
Letko, M., Marzi, A., & Munster, V. (2020). Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B beta coronaviruses. Nature Microbiology, 5(4), 562–569. https://doi.org/10.1038/s41564-020-0688-y
Ministry of Health, Malaysia. (2020). Clinical Management Of Confirmed Covid-19 Case In Adult And Paediatric. Retrieved February 21, 2021, from http://covid-19.moh.gov.my/garis-panduan/garis-panduan-kkm/Annex_2e_Clinical_Management_For_Confirmed_COVID-19_in_Adult_and_Paed.28.09.20.pdf
Montalvan, V., Lee, J., Bueso, T., De Toledo, J., & Rivas, K. (2020). Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. Clinical Neurology and Neurosurgery, 194, 105921. https://doi.org/10.1016/j.clineuro.2020.105921
Richardson, S., Hirsch, J. S., Narasimhan, M., Crawford, J. M., McGinn, T., Davidson, K. W., … Zanos, T. P. (2020). Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA, 323(20), 2052. https://doi.org/10.1001/jama.2020.6775
Rodriguez-Morales, A. J., Cardona-Ospina, J. A., Gutiérrez-Ocampo, E., Villamizar-Peña, R., Holguin-Rivera, Y., Escalera-Antezana, J. P., … Sah, R. (2020). Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Medicine and Infectious Disease, 34, 101623. https://doi.org/10.1016/j.tmaid.2020.101623
Ruan, L., Zhang, Y., Luo, Y., Yu, X., Zeng, Y., Peng, H., … Liu, M. (2020). Clinical features and outcomes of four HIV patients with COVID‐19 in Wuhan, China. Journal of Medical Virology, 93(1), 133–136. https://doi.org/10.1002/jmv.26223
Sim, B. L. H., Chidambaram, S. K., Wong, X. C., Pathmanathan, M. D., Peariasamy, K. M., Hor, C. P., … Goh, P. P. (2020). Clinical characteristics and risk factors for severe COVID-19 infections in Malaysia: A nationwide observational study. The Lancet Regional Health - Western Pacific, 4, 100055. https://doi.org/10.1016/j.lanwpc.2020.100055
Suresh Kumar, V. C., Mukherjee, S., Harne, P. S., Subedi, A., Ganapathy, M. K., Patthipati, V. S., & Sapkota, B. (2020). Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19. BMJ Open Gastroenterology, 7(1), e000417. https://doi.org/10.1136/bmjgast-2020-000417
Wong, H. Y. F., Lam, H. Y. S., Fong, A. H.-T., Leung, S. T., Chan, T. W.-Y., Lo, C. S. Y., … Ng, M.-Y. (2020). Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19. Radiology, 296(2), E72–E78. https://doi.org/10.1148/radiol.2020201160
Wu, Z., & McGoogan, J. M. (2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA, 323(13), 1239. https://doi.org/10.1001/jama.2020.2648
Zhao, J., Liao, X., Wang, H., Wei, L., Xing, M., Liu, L., & Zhang, Z. (2020). Early Virus Clearance and Delayed Antibody Response in a Case of Coronavirus Disease 2019 (COVID-19) With a History of Coinfection With Human Immunodeficiency Virus Type 1 and Hepatitis C Virus. Clinical Infectious Diseases, 71(16), 2233–2235. https://doi.org/10.1093/cid/ciaa408
Zhao, W., Zhong, Z., Xie, X., Yu, Q., & Liu, J. (2020). Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study. American Journal of Roentgenology, 214(5), 1072–1077. https://doi.org/10.2214/ajr.20.22976
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Ahmad Anwaar Muhammad Saifullah, Mohd Rahman Omar, Nour Hanan Daniah Mohd Bakhit, Assyifaa Nik Mazian, Sarah Zulaikha Samad, Nor Safiqah Sharil, Kim Yoon Siow
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
