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Pneumocystis jirovecii pneumonia with hypoxaemia — SCE Acute Medicine MCQ

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HardSepsis and Infectious EmergenciesPneumocystis jirovecii pneumonia with hypoxaemiaSCE Acute Medicine

A 48-year-old man with HIV not taking antiretroviral therapy presents with progressive dyspnoea and dry cough. SpO2 is 88% on air, chest radiograph shows bilateral interstitial infiltrates and LDH is elevated. ABG on air shows PaO2 8.2 kPa. What is the most appropriate next step in management?

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Correct answer: E — Start high-dose co-trimoxazole and adjunctive corticosteroid therapy

The subacute dry cough, hypoxaemia, bilateral interstitial shadowing and HIV risk suggest Pneumocystis jirovecii pneumonia. Adjunctive steroids are indicated with significant hypoxaemia. Typical bacterial pneumonia is usually more acute and focal. Early HIV testing, microbiological confirmation and specialist input should accompany treatment, but therapy should not be delayed in a hypoxic patient.

Reference: BHIVA opportunistic infection guideline, BNF