Pneumocystis jirovecii pneumonia co-infection with cytomegalovirus pneumonia in a patient with acquired immunodeficiency syndrome: A case report and literature review.

Abstract

Cytomegalovirus (CMV) pneumonia is an uncommon presentation of CMV among patients with HIV/AIDS, particularly in co-infection with Pneumocystis jirovecii pneumonia (PCP). A case was reported with a literature review, and a comprehensive literature search was performed using the PubMed/MEDLINE and Scopus databases. We report a 52-year-old male with AIDS presenting with progressively worsening dyspnea over 1 week. One month earlier, he had completed a 21-day course of PCP treatment, showed improvement and was discharged. Two weeks before presentation, he started antiretroviral therapy (ART), but his dyspnea worsened significantly 1 week later. Chest radiography showed bilateral ground glass opacities. Bronchoscopy and lung biopsy revealed nuclear enlargement with prominent intranuclear inclusions and marginated chromatin of alveolar cells on H&E staining, along with positive immunohistochemistry for CMV. Grocott's methenamine silver staining identified 3-5 μm irregular yeast-like organisms resembling crushed ping-pong balls, consistent with P. jirovecii. He was treated with intravenous ganciclovir for a total of 21 days, and his clinical and radiologic findings completely resolved. CMV pneumonia co-infection with PCP is extremely rare and should be considered among patients with severely immunocompromise with interstitial pneumonitis unresponsive to PCP treatment or recurring after treatment.