Department of Medicine, Division of Pulmonary and Critical Care, UCLA (Dr. Yee); Pulmonary & Critical Care Medicine, Virginia Mason Medical Center, Seattle, WA (Dr. Mann); Veterans Administration Puget Sound Health Care System, Seattle, WA (Drs. Crothers and Albert); Department of Medicine, Division of Pulmonary and Critical Care (Dr. Crothers), Division of General Internal Medicine (Dr. Albert), University of Washington, Seattle talbert@uw.edu
The authors reported no potential conflict of interest relevant to this article.
Routine treatment for PCP in patients without HIV is a 21-day course of trimethoprim/sulfamethoxazole (Bactrim). Dosing for patients with normal renal function is 15 to 20 mg/kg orally or intravenously per day. Patients with allergy to trimethoprim/sulfamethoxazole should ideally undergo desensitization, given its effectiveness against PCP.
Due to a sulfonamide allergy, our patientwas started on primaquine 30 mg/d, clindamycin 600 mg tid, and prednisone 40 mg bid. (The corticosteroid was added because of the severity of the disease.) Three days after starting treatment—and 10 days into his hospital stay—the patient had significant improvement in his respiratory status and was successfully extubated. He underwent trimethoprim/sulfamethoxazole desensitization and completed a 21-day course of treatment for PCP with complete resolution of respiratory symptoms. Follow-up chest radiograph 2 months later (FIGURE 2) confirmed clearance of opacities.
THE TAKEAWAY
PCP remains a rare disease in patients without the typical immunosuppressive risk factors. However, it should be considered in patients with cirrhosis who develop respiratory failure, especially those with compatible radiographic findings and negative microbiologic evaluation for other, more typical, organisms.
CORRESPONDENCE Tyler Albert, MD, VA Puget Sound Healthcare System, 1660 South Columbian Way, S-111-Pulm, Seattle, WA 98108; talbert@uw.edu