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Pneumocystis jirovecii pneumonia — SCE Respiratory MCQ

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HardRespiratory InfectionsPneumocystis jirovecii pneumoniaSCE Respiratory

A 28-year-old man with HIV and CD4 count 80 cells/mm3 presents with dry cough, fever and progressive dyspnoea. CXR shows bilateral perihilar interstitial shadowing. ABG on air shows PaO2 8.0 kPa and A-a gradient is raised. LDH is elevated. What is the most appropriate management?

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Correct answer: E — Co-trimoxazole plus adjunctive corticosteroids

Pneumocystis jirovecii pneumonia is likely in advanced HIV with dry cough, bilateral interstitial changes and hypoxaemia; co-trimoxazole is first-line and adjunctive steroids are indicated with significant hypoxaemia. Amoxicillin alone does not cover Pneumocystis. TB therapy or itraconazole monotherapy would miss the likely pathogen.

Reference: BHIVA opportunistic infection guidance; BNF