AIDS‐Related Extrapulmonary Pneumocystis carinii Infection Presenting as a Solitary Rectal Ulcer

Abstract

Since the widespread adoption of prophylaxis against Pneumocystis carinii, the incidence of infection as an indicator disease for acquired immunodeficiency syndrome (AIDS) has declined from 53% in 1989 to 16% in 1993 (1). Despite this, P carinii still remains a significant problem in human immunodeficiency virus (HIV)-infected patients and P carinii pneumonia (PCP) remains the leading diagnostic indicator for the new diagnosis of AIDS in the United States (1). Extrapulmonary infection with P carinii, although uncommon, has been more frequently reported in the past few years (2-17). Aerosolized pentamidine has been considered a contributing factor in the development of extrapulmonary P carinii infection in many of these reports (5-17). As aerosolized pentamidine achieves high pulmonary concentrations with minimal systemic absorption (18), it is hypothesized that pulmonary infection is suppressed without the benefit of EM YOSHIDA, D FILIPENKO, P PHILLIPS, JSG MONTANER, JS WHITTAKER. AIDS-related extrapulmonary Pneumocystis carinii infection presenting as a solitary rectal ulcer. Can J Gastroenterol 1996;10(6):401-404. Extrapulmonary infection with Pneumocystis carinii, although uncommon, is increasingly recognized. Use of aerosolized pentamidine versus a systemic medication is thought to be a contributing factor due to the low concentrations of drug that are incapable of suppressing systemic infection. Infection with P carinii has been reported in every organ system including the gastrointestinal system. A 28-year-old acquired immunodeficiency syndrome patient receiving prophylaxis with aerosolized pentamidine who presented with a solitary rectal ulcer is reported. Initial biopsy was characteristic of extrapulmonary P carinii infection, with numerous organisms present. Occasional cytomegalovirus inclusion bodies were noted which may have been a copathogen but which were not treated. Treatment with intravenous pentamidine resulted in documented eradication of P carinii and complete resolution of the ulcer. Although lower gastrointestinal pneumocystosis has been described without ulceration, this is the first description of rectal ulceration presenting as the initial manifestation of extrapulmonary pneumocystosis. Key Words: Acquired immunodeficiency syndrome, Extrapulmonary Pneumocystis carinii, Rectal ulcerInfection extra-pulmonaire à Pneumocystis carinii liée au SIDA sous la forme d'un ulcère rectal solitaire RÉSUMÉ : L'infection extra-pulmonaire à Pneumocystis carinii, bien que rare, est de plus en plus observée. L'utilisation de la pentamidine en aérosol versus un médicament systémique pourrait être un facteur contributif à cause des faibles concentrations du médicament qui sont incapables de supprimer l'infection systémique. L'infection à P. carinii a été signalée dans tous les organes, y compris dans l'appareil digestif. Nous décrivons ici le cas d'un patient de 28 ans atteint du syndrome de l'immuno-déficience acquise ayant reçu en prophylaxie de la pentamidine en aérosol et qui a présenté un ulcère rectal s...

Long‐term outcome of laparoscopic mesh rectopexy for solitary rectal ulcer syndrome

“…Rectal prolapse (internal or external) [3], defaecation disorders [4] and pelvic floor abnormalities are most frequently implicated. Other causes of ulceration are also reported, including trauma from self‐digitation [5,6], anal intercourse and infections in the immuno‐compromised patient such as Pneumocystis carinii [7].…”

PCR diagnosis of Pneumocystis carinii on sputum and bronchoalveolar lavage samples in immuno-compromised patients

“…P. carinii infection causes a radiographically diffuse, bilateral pneumonia characterized by an eosinophilic intra-alveolar exudate and mild plasma cell interstitial pneumonitis (Wilkin and Feinberg 1999). It is an extracellular organism commonly found in the alveolar spaces of the lung but rarely in extrapulmonary sites (Yoshida et al 1996). Although the incidence of PCP has declined in the developed world as a result of prophylaxis and effective antiretroviral therapy, its incidence has increased in underdeveloped countries including Thailand, where the incidence of AIDS is high (Ruxrungtham and Phanuphak 2001).…”

Extrapulmonary Pneumocystis Jirovecii Presenting as Fever and Lymphadenopathies. Case Report and Literature Review

“…The distribution of this drug within the lung, when administered this way, is not uniform [10] has no systemic effects. Therefore, it may be insufficient to prevent systemic dissemination and to suppress P. jirovecii out of the lung, which explains its association as a risk factor for extrapulmonary pneumocystosis [11,6].…”