A Case of Severe Pneumocystis Pneumonia in an HIV-Negative Patient Successfully Treated with Oral Atovaquone

Figures & data

Figure 1 Chest X-ray image showing a bilateral diffuse symmetric reticular interstitial shadow (A). A chest computed tomography scan showing bilateral asymmetric patchy mosaic appearance and ground-glass opacities in the lung subpleural peripheral regions (B and C).

Figure 2 Clinical course of the patient in the present case.

Table 1 Clinical Characteristics of the Present Patient and an Earlier Patient with Severe PCP

	Present Case	Previously Reported Case^Citation20
Age	63	64
Sex	Female	Female
Underlying disease	Mixed connective tissue, interstitial pneumonia	Glucose-6-phosphate dehydrogenase enzyme deficiency, brain tumor
Reasons for developing Pneumocystis pneumonia	Long-term use of corticosteroids without prophylaxis	Long-term use of corticosteroids without prophylaxis, chemotherapy
Serum lactate dehydrogenase (mg/dL)	499	855
Serum KL-6 (IU/L)	595	Unknown
Serum beta-d-glucan (pg/mL)	155	Unknown
O2 saturation (%)	85	88
PaO2 (mmHg)	94 (nasal oxygen 2L/min)	56
Regimen of atovaquone	750 mg twice per day	750 mg three times per day
Adjunctive corticosteroid	Yes	Yes
Duration of treatment (days)	21	Unknown
Side effect of atovaquone	None	None
Previous use of other anti-Pneumocystis agents for treatment	None	None
Previous use of other anti-Pneumocystis agents for prophylaxis	None	None
Prognosis	Survive	Survive

Masur H, Brooks JT, Benson CA, et al. Prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: updated guidelines from the Centers for Disease Control and Prevention, National Institutes of Health, and HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2014;58(9):1308–1311.

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Data Sharing Statement

The data is available upon request.