A 32-year-old male presents with dyspnea and a nonproductive cough. His is tachycardic, tachypneic and febrile. Auscultation of his chest reveals scattered rhonchi. His chest x-ray demonstrates a diffuse interstitial infiltrates. His ABG demonstrates moderate hypoxemia and his LDH is elevated. What is the most likely diagnosis?
- Streptococcal pneumoniae pneumonia
- Mycoplasma pneumoniae pneumonia
- Pneumocystis carinii pneumonia
- Bowen's disease
- Steven-Johnson syndrome
Pneumocystis carinii pneumonia
Formerly PCP Pneumonia now called (PJP) Pneumocystis jiroveci. Many AIDS patients present initially with PJP. These are the classic signs and symptoms of PJP pneumonia. While mycoplasma patients can be acutely ill, they are more likely (especially on the Boards) to present as mildly ill with a normal physical exam and no hypoxia. S. pneumonia is the most common community-acquired pneumonia but would present with a focal/lobar consolidation.
- Common in HIV-infected patients with a low CD4 count of less than 200
- Prophylaxis for high-risk patients with a CD4 count of less than 200 or with a history of PJP infection