Pneumocystis: The Daily PANCE Blueprint

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Pneumocystis: The Daily PANCE Blueprint

A 38-year-old HIV-positive male presents to the ER with a dry cough. Vitals are remarkable for tachypnea (RR 30 breaths/min), tachycardia (HR 112 bpm), and fevers (T max 102.4F). Labs show elevated LDH and leukocytosis. CD4 count is pending. CXR demonstrates bilateral interstitial opacities. What is the best treatment for this patient?

A. Amantadine
B. Tetracycline
C. Fluconazole
D. Trimethoprim-sulfamethoxazole
E. Ampicillin and doxycycline

Answer and topic summary

The answer is D. Trimethoprim-sulfamethoxazole

Pneumocystis pneumonia or Pneumocystis jirovecii pneumonia (PCP) is an opportunistic fungal infection that occurs in the lungs of people who are immunocompromised (e.g., HIV, stem cell transplant patients, on chronic steroids). Clinical features include dyspnea, fatigue, cough, and hypoxia. Labs may show elevated β-d-Glucan and LDH levels. CXR may demonstrate diffuse, bilateral, symmetrical interstitial infiltrates (classically a butterfly pattern). It’s important to note it may not show up early on in the disease. Diagnosis is confirmed if PCP is detected on a sputum culture or BAL. Management is Bactrim +/- adjunctive steroids.

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Covered under ⇒PANCE Blueprint Infectious Disease ⇒ Fungal Disease ⇒ Pneumocystis

Also covered as part of the Internal Medicine EOR topic lists

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