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Pneumocystis jirovecii pneumonia — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesPneumocystis jirovecii pneumoniaSCE Acute Medicine

A 48-year-old man on prolonged high-dose prednisolone for vasculitis presents with dry cough and progressive dyspnoea. Chest radiograph is near normal but CT shows bilateral ground-glass opacities. Oxygen saturation is 87% on air and LDH is raised. HIV test is pending. What is the most appropriate next step in management?

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Correct answer: D — Start high-dose co-trimoxazole and adjunctive corticosteroid if hypoxaemic

Immunosuppression, dry cough, hypoxaemia and ground-glass change suggest Pneumocystis pneumonia, treated with high-dose co-trimoxazole; adjunctive steroids are used when significantly hypoxaemic. A near-normal chest radiograph does not exclude PJP. TB treatment may be needed for another presentation but does not fit as well as PJP here. The pearl is that CT can be far more sensitive than plain radiography in opportunistic pneumonia.

Reference: BHIVA opportunistic infection guidance; BNF