A Rare Case of Splenic Pneumocystis jirovecii in a HIV-Positive Patient
Introduction. Human immunodeficiency virus (HIV) positive individuals with the CD4 count less than 200 cells/mm3 are at risk for opportunistic infections. Pneumocystis jirovecii, a fungal pathogen, is a common cause of opportunistic infections with predominantly pulmonary involvement. Disseminated P...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Case Reports in Gastrointestinal Medicine |
| Online Access: | http://dx.doi.org/10.1155/2020/8509591 |
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| author | Hafsa Abbas Harish Patel Ahmed Baiomi Masooma Niazi Trupti Vakde Sridhar Chilimuri |
| author_facet | Hafsa Abbas Harish Patel Ahmed Baiomi Masooma Niazi Trupti Vakde Sridhar Chilimuri |
| author_sort | Hafsa Abbas |
| collection | DOAJ |
| description | Introduction. Human immunodeficiency virus (HIV) positive individuals with the CD4 count less than 200 cells/mm3 are at risk for opportunistic infections. Pneumocystis jirovecii, a fungal pathogen, is a common cause of opportunistic infections with predominantly pulmonary involvement. Disseminated P. jiroveciii infection presenting with hepatosplenic lesion is extremely rare. Case Summary. A 31-year-old male with HIV with and acquired immunodeficiency syndrome (AIDS) presented with diarrhea for 3 weeks. He had splenomegaly and inguinal lymphadenopathy on physical examination. Laboratory parameters revealed anemia and hypoalbuminemia, while stool studies for infectious etiology and fecal leucocyte were negative. Computed tomography (CT) of the chest and abdomen depicted consolidation of the lungs and a large splenic mass. He underwent fiberoptic bronchoscopy with transbronchial biopsy which was consistent with P. jirovecii pneumonia. He also had a ultrasound-guided core biopsy of the splenic mass which revealed necrotizing granulomas with Pneumocystis jirovecii infection on Grocott-Gomori's methenamine silver (GMS) stain and was initiated on treatment for P. jirovecii with sulfamethoxazole with trimethoprim. Conclusion. Malignancy and atypical infection are key differentials in patients presenting with hepatosplenic lesions. HIV positive patients are at increased risk of AIDS-related lymphoma. Tissue diagnosis is often required for further evaluation. Disseminated P. jirovecii presenting with splenic mass and liver lesion is extremely rare. |
| format | Article |
| id | doaj-art-995baafa7b02465eb86ec0ee033769b0 |
| institution | OA Journals |
| issn | 2090-6528 2090-6536 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Gastrointestinal Medicine |
| spelling | doaj-art-995baafa7b02465eb86ec0ee033769b02025-08-20T02:10:17ZengWileyCase Reports in Gastrointestinal Medicine2090-65282090-65362020-01-01202010.1155/2020/85095918509591A Rare Case of Splenic Pneumocystis jirovecii in a HIV-Positive PatientHafsa Abbas0Harish Patel1Ahmed Baiomi2Masooma Niazi3Trupti Vakde4Sridhar Chilimuri5Division of Gastroenterology, BronxCare Hospital Center, Bronx, NY 10457, USADivision of Gastroenterology, BronxCare Hospital Center, Bronx, NY 10457, USADivision of Gastroenterology, BronxCare Hospital Center, Bronx, NY 10457, USADepartment of Pathology, BronxCare Hospital Center, Bronx, NY 10457, USADepartment of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USADepartment of Medicine, BronxCare Hospital Center, Bronx, NY 10457, USAIntroduction. Human immunodeficiency virus (HIV) positive individuals with the CD4 count less than 200 cells/mm3 are at risk for opportunistic infections. Pneumocystis jirovecii, a fungal pathogen, is a common cause of opportunistic infections with predominantly pulmonary involvement. Disseminated P. jiroveciii infection presenting with hepatosplenic lesion is extremely rare. Case Summary. A 31-year-old male with HIV with and acquired immunodeficiency syndrome (AIDS) presented with diarrhea for 3 weeks. He had splenomegaly and inguinal lymphadenopathy on physical examination. Laboratory parameters revealed anemia and hypoalbuminemia, while stool studies for infectious etiology and fecal leucocyte were negative. Computed tomography (CT) of the chest and abdomen depicted consolidation of the lungs and a large splenic mass. He underwent fiberoptic bronchoscopy with transbronchial biopsy which was consistent with P. jirovecii pneumonia. He also had a ultrasound-guided core biopsy of the splenic mass which revealed necrotizing granulomas with Pneumocystis jirovecii infection on Grocott-Gomori's methenamine silver (GMS) stain and was initiated on treatment for P. jirovecii with sulfamethoxazole with trimethoprim. Conclusion. Malignancy and atypical infection are key differentials in patients presenting with hepatosplenic lesions. HIV positive patients are at increased risk of AIDS-related lymphoma. Tissue diagnosis is often required for further evaluation. Disseminated P. jirovecii presenting with splenic mass and liver lesion is extremely rare.http://dx.doi.org/10.1155/2020/8509591 |
| spellingShingle | Hafsa Abbas Harish Patel Ahmed Baiomi Masooma Niazi Trupti Vakde Sridhar Chilimuri A Rare Case of Splenic Pneumocystis jirovecii in a HIV-Positive Patient Case Reports in Gastrointestinal Medicine |
| title | A Rare Case of Splenic Pneumocystis jirovecii in a HIV-Positive Patient |
| title_full | A Rare Case of Splenic Pneumocystis jirovecii in a HIV-Positive Patient |
| title_fullStr | A Rare Case of Splenic Pneumocystis jirovecii in a HIV-Positive Patient |
| title_full_unstemmed | A Rare Case of Splenic Pneumocystis jirovecii in a HIV-Positive Patient |
| title_short | A Rare Case of Splenic Pneumocystis jirovecii in a HIV-Positive Patient |
| title_sort | rare case of splenic pneumocystis jirovecii in a hiv positive patient |
| url | http://dx.doi.org/10.1155/2020/8509591 |
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