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Pneumocystis jirovecii pneumonia — SCE Respiratory MCQ

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HardRespiratory InfectionsPneumocystis jirovecii pneumoniaSCE Respiratory

A 39-year-old man with advanced HIV presents with 3 weeks of dry cough and exertional dyspnoea. CD4 count is 58 cells/mm3. CXR shows bilateral perihilar interstitial infiltrates; ABG on air shows PaO2 8.0 kPa. LDH is raised and beta-D-glucan is positive. What is the most appropriate management?

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Correct answer: B — High-dose co-trimoxazole plus adjunctive corticosteroids

Pneumocystis pneumonia is likely, and hypoxaemia at this level warrants co-trimoxazole with adjunctive corticosteroids. Standard CAP therapy, TB treatment and voriconazole do not cover the most likely organism. Bronchoscopy can confirm diagnosis but treatment should not be delayed in a hypoxaemic immunocompromised patient.

Reference: BHIVA Opportunistic Infection guidance; BNF