Pneumocystis jirovecii pneumonia (PJP): The Daily PANCE Blueprint
A 28-year-old woman with a history of IV drug abuse and poorly controlled HIV presents to the emergency department with severe cough and shortness of breath. She reports using IV heroin daily and smoking one pack of cigarettes per day. On examination, her temperature is 38.5°C (101.3°F), pulse rate is 112/min, and respirations are 28/min. Oxygen saturation is 86% on room air. Physical examination reveals diffuse crackles in both lungs and a rash on her lower extremities. Arterial blood gas shows a pH of 7.45, pCO2 of 30 mm Hg, and pO2 of 54 mm Hg. Her serum lactate dehydrogenase level is 700 IU/L. Chest X-ray reveals bilateral diffuse infiltrates predominantly in the upper lobes. What is the most appropriate initial treatment for this patient?
A. High-dose corticosteroids
B. Intravenous furosemide
C. Broad-spectrum antibiotics
D. Intravenous trimethoprim-sulfamethoxazole
E. Inhaled bronchodilators
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Infectious Disease ⇒ Fungal Disease ⇒ Pneumocystis (Lecture)