P. jiroveci Pneumonia

Compromised

Step 1: View clinicals

A 48 year old woman presents with progressive dyspnea for 1 week. There was no cough or chest pain. She was diagnosed with metastatic cancer of the right breast 1 year ago, for which a radical mastectomy was performed. She completed her 6th cycle of chemotherapy three months ago. On admission, her oxygen saturation was 82%, which improved to 99% with high flow oxygen. A full blood count and chest x-ray are normal.


Step 2: Order all relevant investigations

HRCT chest

There are patchy areas of ground-glass attenuation, in a background of interlobular septal thickening.

Sputum induction & culture

Gram stain: negative Giemsa & Methenamine Silver stains: negative Culture results will be available in 3 days.

Arterial blood gas

On room air: pH: 7.46 (7.35 - 7.45) pO2: 68 mmHg (> 79 on room air) PCO2: 32 mmHg (35 - 45) HCO3: 23 mmol/l (24 - 32)

Bronchoalveolar lavage

A Giemsa stain reveals multiple thick walled cysts and pleomorphic trophozoites with reddish nuclei and bluish cytoplasm. The cyst walls are stained by Methenamine Silver. Blood is not seen in any lavage aliquots.


Step 3: Select appropriate management

Cotrimoxazole
Prednisolone
DVT Prophylaxis
Intubation & Ventilation stat


Score: ★★☆