Zapalenie płuc wywołane przez Pneumocystis jiroveci u chorego we wczesnym okresie po przeszczepieniu nerki

Abstract

The article presents a case of interstitial pneumonia caused by Pneumocystis jiroveci (PJ) in a patient shortly after kidney transplantation (KTx), who did not receive routine prophylaxis with sulfamethoxa­zole/trimethoprim (SMX/TMP). At first the patient re­ported non-specific symptoms: malaise, dyspnoea on exertion, dry cough and fever. On subsequent days the status of the patient quickly deteriorated with dyspnoea at rest, hypoxemia and ground-glass opacity in both lungs. Since there was clinical sus­picion of PJ pneumonia (PCP), the patient received empirical treatment with high doses of SMX/TMP, high-dose steroids and reduced dosages of immu­nosupressive drugs. During treatment side effects were observed — skin rash and oral mucosa le­sions, therefore symptomatic treatment was admin­istered and the treatment with SMX/TMP was con­tinued. The positive outcome of the treatment in our patient proves that PCP should be suspected in ev­ery patient after organ transplantation with interstitial lung changes and empirical treatment should be ad­ministered until microbiological confirmation of PCP. The occurrence of PJ in the presented case confirms the need of prophylactic treatment with SMX/TMP within the early period following KTx.