Pneumocystis in metastatic lung cancer, a pragmatic approach in support of prophylaxis

Paz, David Luque; Jouneau, S.; Tattevin, Pierre; Ricordel, Charles

doi:10.1136/bcr-2019-232895

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…In previous studies, the clinicopathological characteristics of lung cancer patients diagnosed with PCP were chemoradiotherapy treatment, metastatic lung cancer, prior steroid treatment, and HIV infection [ 3 , 12 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pneumocystis pneumonia (PCP), caused by Pneumocystis jirovecii (P. jirovecii) , is a common opportunistic infection associated with high mortality rates [ 1 , 2 ]. Well-defined risk factors for PCP include immunocompromised status, human immunodeficiency virus (HIV) infection, organ transplantation, and hematological malignancies [ 3 ]. There are some case reports on the diagnosis and high mortality rate of PCP in immunocompromised patients [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Well-defined risk factors for PCP include immunocompromised status, human immunodeficiency virus (HIV) infection, organ transplantation, and hematological malignancies [ 3 ]. There are some case reports on the diagnosis and high mortality rate of PCP in immunocompromised patients [ 3 , 4 , 5 ]. However, herein, we report the case of a non-immunocompromised lung cancer patient who developed PCP after right upper lobe (RUL) lobectomy and mediastinal lymph node dissection (MLND).…”

Section: Introductionmentioning

confidence: 99%

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Pneumocystis Pneumonia in a Non-Immunocompromised Lung Cancer Patient after Surgery: A Case Report

et al. 2022

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We present the Pneumocystis pneumonia case of a 64-year-old man with no remarkable history except for hypertension, who had not undergone any treatment other than surgery. On postoperative day 7, high-resolution computed tomography findings revealed multifocal ground-glass opacifications with interlobular septal thickening in both lungs; therefore, atypical pneumonia was suspected. Polymerase chain reaction (PCR) test performed after bronchoalveolar lavage was positive for Pneumocystis jirovecii (P jirovecii). Based on the PCR results, a final diagnosis of Pneumocystis pneumonia (PCP) was made. After treatment, he improved and was discharged. This is a unique case of PCP diagnosis in a non-immunocompromised patient, with no remarkable history except for hypertension, who had not undergone any treatment other than surgery for cancer. Thus, it is necessary to consider additional risk factors for PCP and timing of preventive treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pneumocystis Pneumonia in a Non-Immunocompromised Lung Cancer Patient after Surgery: A Case Report

et al. 2022

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Methylprednisolone

2021

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Pneumocystis jirovecii pneumonia: case reportAn 84-year-old man developed Pneumocystis jirovecii pneumonia during treatment with methylprednisolone for symptomatic brain metastases.The man, who was a non-smoker and HIV-negative, was diagnosed with a non-small cell lung carcinoma in August 2015 at the age of 83 years. He went into complete remission after 6 cycles of carboplatin and etoposide with thoracic radiation. In December 2016, a stage I right lower lobe lung adenocarcinoma was discovered, which was treated with lobectomy. In April 2017, a neurological impairment showed a frontal brain metastasis, and he received treatment with radiotherapy associated with methylprednisolone initially at 100 mg/day and then reduced to 50 mg/day [route not stated]. In June 2017, he presented with dry cough and shortness of breath associated with self-reported fever. Two days later, he was admitted to the hospital. On admission, he had fever, with blood pressure 108/61 mm Hg, regular pulse rate 79 bpm, respiration rate 18 cycles/min, and oxygen saturation 95% with 2 L/min of oxygen supplementation. He had no recent chemotherapy, and no immunosuppressive treatment other than methylprednisolone. Blood laboratory tests were as follows: haemoglobin concentration 129 g/L, platelet count 244000 × 10 9 /L, WBC count 6400/mm3 and neutrophil count 3900 /mm 3 with no cytopenia. No renal dysfunction was found as estimated glomerular filtration rate of >60 mL/min. Chest CT scan revealed bilateral excavated nodules evoking lung abscesses, associated with diffuse bilateral ground glass opacities. A bronchoalveolar lavage (BAL) was immediately performed with good tolerance, for bacteriological and mycological analyses. Blood culture and serum galactomannan antigen were found to be negative. BAL results showed the presence of P. jiroveci with Gomori-Grocott staining, indirect immunofluorescence and positive pneumocystis PCR at the 21st cycle of amplification, as well as a few colonies of Aspergillus fumigatus in culture, Actinomyces odontolyticus in culture were found with Nocardia nova susceptible to cotrimoxazole [trimethoprim-sulfamethoxazole]. To explain the acute respiratory failure, the role of A. odontolyticus was discarded, which was found to be a contamination during the BAL procedure. Images of lung abscesses were compatible with N. nova, but nocardiosis not explained the rapid clinical degradation. As he had no neutropenia and a negative A. fumigatus PCR in BAL, made the possibility of rapidly lethal invasive aspergillosis less likely. The association of diffuse bilateral ground-glass opacities, very low cycle threshold value of pneumocystis PCR in BAL, a positive direct examination and a deep hypoxaemia progressing into severe acute respiratory failure, attributed the death of the patient to a Pneumocystis jirovecii pneumonia, rather than other coinfections. A final diagnosis Pneumocystis jirovecii pneumonia secondary to methylprednisolone was made.The man received treatment with ceftriaxone and spiramycin [rovamycin] for communi...

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Incidence, caractéristiques et survie des patients présentant une pneumocystose en oncologie solide

Peinoit,

Muzellec,

Neveu

et al. 2024

Bulletin du Cancer

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Pneumocystis in metastatic lung cancer, a pragmatic approach in support of prophylaxis

Cited by 3 publications

References 16 publications

Pneumocystis Pneumonia in a Non-Immunocompromised Lung Cancer Patient after Surgery: A Case Report

Pneumocystis Pneumonia in a Non-Immunocompromised Lung Cancer Patient after Surgery: A Case Report

Methylprednisolone

Incidence, caractéristiques et survie des patients présentant une pneumocystose en oncologie solide

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