LAUSR

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Pneumocystis carinii pneumonia (PCP) is an AIDS-defining illness, associated with significant morbidity and mortality. It is also found in patients with other immunosuppressive conditions such as organ transplant and malignancies (1). We present 4 cases of PCP in post-COVID 19 patients. All cases were HIV negative. CASE PRESENTATION: Case 1: A 30-year old female was admitted with a 1-month history of worsening shortness of breath (SOB) and productive cough. She had no known co-morbids and no history of corticosteroid use. Her oxygen saturation (SpO2) was 85% and respiratory rate (RR) was 35 breaths/minute (BPM). Chest examination revealed bibasilar crackles and CT scan showed bilateral (B/L) ground-glass haziness along with interlobular septal thickening. Patient's COVID-19 test was negative however her antibodies were reactive. Bronchoalveolar lavage (BAL) came back positive for PCP. Patient was managed with co-trimoxazole 48 hourly and prednisolone 25 mg BID.Case 2: A 70-year old male was admitted with high grade fever and SOB for 4 days. He was a known hypertensive, with a history of severe COVID-19 pneumonia 1.5 months back for which he was managed with IV tocilizumab and dexamethasone. His SpO2 was 63% and RR was 73 BPM. Chest examination revealed unilateral (U/L) reduced breath sounds. Chest X-ray showed U/L consolidation and sputum for PCP tested positive. Patient was shifted to the ICU and intubated for respiratory failure. He expired after 4 days of ICU stay.Case 3: A 71-year old male was admitted with SOB for 3 days. He was a known diabetic and hypertensive, with a history of severe COVID-19 pneumonia 1.5 months back, for which he was treated with IV tocilizumab and corticosteroids. His SpO2 was 93% and RR was 28 BPM. Chest examination revealed bibasilar crackles. His CT scan revealed B/L ground-glass haziness, and BAL was positive for PCP. Patient was managed with co-trimoxazole 8 hourly and prednisolone 20 mg BID.Case 4: A 28-year old female was electively admitted for induction chemotherapy. She was a known case of Acute Myeloid Leukemia with a history of COVID-19 infection 1 month back for which she was managed at home. During her hospital stay, she developed persistent cough and febrile neutropenia. Chest examination revealed bibasilar crackles and CT scan showed B/L ground-glass haze. BAL was positive for PCP. She was managed with co-trimoxazole 8 hourly and prednisolone 20 mg BID. DISCUSSION: A number of infectious sequelae have been described in post-COVID 19 patients. Few case reports of concurrent PCP and COVID-19 infection exist in literature (2), however there is only 1 case report of PCP as a post-COVID 19 sequela (3). CONCLUSIONS: This case series highlights the importance of being vigilant for infectious sequelae associated with SARS-CoV-2. REFERENCE #1: Schmidt, J.J., Lueck, C., Ziesing, S. et al. Clinical course, treatment and outcome of Pneumocystis pneumonia in immunocompromised adults: a retrospective analysis over 17 years. Crit Care 22, 307 (2018). REFERENCE #2: Bhat P, Noval M, Doub JB, Heil E. Concurrent COVID-19 and Pneumocystis jirovecii pneumonia in a severely immunocompromised 25-year-old patient. International Journal of Infectious Diseases. 2020 Oct 1;99:119-21. REFERENCE #3: Viceconte G, Buonomo AR, Lanzardo A, Pinchera B, Zappulo E, Scotto R, Schiano Moriello N, Vargas M, Iacovazzo C, Servillo G, Gentile I. Pneumocystis jirovecii pneumonia in an immunocompetent patient recovered from COVID-19. Infectious Diseases. 2021 May 4;53(5):382-5. DISCLOSURES: No relevant relationships by Maaha Ayub, source=Web Response No relevant relationships by Mustafa Bin Ali Zubairi, source=Web Response No relevant relationships by Ali Zubairi, source=Web Response