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PJP — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesPJPRACP Adult Medicine

A 55-year-old renal transplant recipient presents with fever and dry cough 4 months post-transplant. CXR shows bilateral diffuse ground-glass opacities. SpO₂ is 88% on room air. LDH is elevated. Bronchoalveolar lavage with silver stain shows cyst-like organisms. What is the most likely opportunistic infection?

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Correct answer: E — Pneumocystis jirovecii pneumonia

Bilateral diffuse ground-glass opacities with hypoxia, elevated LDH, and silver stain showing cysts in an immunosuppressed transplant recipient is Pneumocystis jirovecii pneumonia (PJP). Treatment is high-dose TMP-SMX (15–20 mg/kg/day of TMP component) IV for 21 days. Adjunctive prednisolone if PaO₂ <70 mmHg. PJP prophylaxis should have been given.

Reference: eTG Antibiotic – 2025 – PJP; TSANZ 2024 Transplant Guidelines