Pneumocystis jirovecii pneumonia in an immunocompetent patient recovered from COVID-19

Abstract

Background

Several cases of invasive fungal diseases in patients with COVID-19 have been reported, mostly due to Aspergillus spp., with anecdotic reports of Pneumocystis jirovecii pneumonia (PJP) as co-infections in immunocompromised patients. We describe the first case of PJP in an immunocompetent patient who recovered from COVID-19 pneumonia.

Case description

Our patient was hospitalized for 18 d for respiratory failure due to Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pneumonia and successfully treated with continuous positive airway pressure (CPAP) respiratory support, enoxaparin, ceftaroline and intravenous 6 mg of dexamethasone for 10 d, then with oral prednisone tapering. Despite his improved radiological and clinical conditions at discharge, he was admitted again after 18 d for worsening of respiratory conditions. Upon the second admission, a high-resolution CT-scan of the chest showed the development of new ground-glass opacities and P. jirovecii was detected on bronchoalveolar lavage fluid. A therapy with trimethoprim-sulphamethoxazole 20 mg/kg and methylprednisolone 40 mg i.v. bis in die (BID) was started, with improvement of clinical, biochemical and radiological conditions.

Conclusions

COVID-19 patients may have multiple risk factors for development of PJP, in particular lymphopaenia and use of steroids. PJP must be ruled out with direct microbiological methods in patients presenting with radiologic and clinical features of possible or probable PJP, even in immunocompetent hosts.

Keywords:

• COVID-19
• Pneumocystis jirovecii
• SARS-CoV-2
• lymphopaenia
• invasive fungal disease

Acknowledgements

Federico II COVID-team (Borrelli Francesco, Buonomo Antonio Riccardo, Cattaneo Letizia, Conte Maria Carmela Domenica, Cotugno Mariarosaria, Di Filippo Giovanni, Foggia Maria, Gallicchio Antonella, Gentile Ivan, Giaccone Agnese, Lanzardo Amedeo, Mercinelli Simona, Minervini Fulvio, Piccione Amerigo, Pinchera Biagio, Reynaud Laura, Salemi Fabrizio, Sardanelli Alessia, Schiano Moriello Nicola, Scordino Fabrizio, Scotto Riccardo, Stagnaro Francesca, Tosone Grazia, Viceconte Giulio, Zappulo Emanuela, Zotta Irene).

Consent for publication

The patient has signed a consent to authorise the publication of his clinical case and his radiological pictures.

Disclosure statement

The authors have no conflicts of interest to disclose.

Data availability statement

Clinical file and images are available upon contact with the corresponding author.