Concurrent Cryptococcal and Pneumocystis Pneumonia along with Pulmonary Tuberculosis in an HIV-Positive Patient: Lessons Learned for Early Management

Case: We are presenting a 50-year-old patient of pulmonary tuberculosis, on anti-tuberculosis therapy (ATT) for last 2 months who presented with fever, cough, breathlessness, anorexia, and weight loss. The case was found to be HIV reactive. His sputum sample showed Candida albicans and Pneumocystis...

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Bibliographic Details
Published in:Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002) Ill. : 2002), 2011-05, Vol.10 (3), p.146-149
Main Authors: Kaur, Ravinder, Gautam, Hitender, Maheshwari, Megha, Goyal, Ritu, Bhalla, Preena, Dewan, Richa
Format: Article
Language:English
Subjects:
Amphotericin B
Amphotericin B - therapeutic use
Anorexia
Antifungal Agents - therapeutic use
Candida albicans
Cerebrospinal fluid
cotrimoxazole
Cough
Cryptococcus neoformans
Dysphagia
Fever
fluconazole
Fungal infections
Headache
HIV
HIV Infections - drug therapy
Human immunodeficiency virus
Humans
Lung
Meningitis, Cryptococcal - diagnosis
Morbidity
Mortality
Mycobacterium
Opportunist infection
Patients
Pneumocystis
Pneumonia
Pneumonia, Pneumocystis
Sputum
Sulfamethoxazole
Tuberculosis
Tuberculosis, Pulmonary
Vomiting
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Summary:Case: We are presenting a 50-year-old patient of pulmonary tuberculosis, on anti-tuberculosis therapy (ATT) for last 2 months who presented with fever, cough, breathlessness, anorexia, and weight loss. The case was found to be HIV reactive. His sputum sample showed Candida albicans and Pneumocystis jirovecii. Fluconazole and cotrimoxazole + sulphamethoxazole were added. The index case did not respond to the treatment and his clinical condition started to deteriorate and he developed headache, vomiting, and dysphagia. Repeat sputum sample and cerebrospinal fluid (CSF) showed Cryptococcus neoformans which was found to be sensitive to Amphotericin B. Amphotericin B was added to the treatment and patient clinically responded to treatment. In conclusion, emphasis should be given to correct etiological identification, allowing appropriate treatment and decreasing the morbidity and mortality in these patients as concomitant opportunistic infections may cause diagnostic problems.
ISSN:1545-1097
2325-9574
1557-0886
2325-9582
DOI:10.1177/1545109710397767