International Journal of STD & AIDS > Volume 18, Number 2 > Pp. 134-137

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Panos, G. Z Articles by Falagas, M. E Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?

Case reports

Multi-skeletal Pneumocystis jiroveci (carinii) in an HIV-seropositive patient

George Z Panos, Ioannis Karydis, Stamatios E Velakoulis and Matthew E Falagas

1st IKA Hospital, Penteli, Athens, Greece; 1st IKA Hospital, Penteli, Athens, Greece; Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

We present our experience with skeletal involvement of Pneumocystis jiroveci (ex P. carinii) infection in an HIV-seropositive patient. The objective of this study was to alert clinicians to the possibility that extrapulmonary P. jiroveci could affect the skeletal system in HIV-infected patients with extremely rapid progression. P. jiroveci infection of skeletal system has been rarely described elsewhere. A 51-year-old man complained of fever for six weeks, cough, anorexia, fatigue, and chest pain. He was found to be HIV seropositive. Repetitive (six samples) sputum and bronchoalveolar lavage fluid microbiologic tests were negative. High-resolution chest computed tomography (CT) scan revealed a small pulmonary mass. Abdominal CT scan revealed lesions in liver, spleen, kidneys, adrenal glands, lumbar vertebrae, and sacrum. Brain and skull CT scan was normal. A fine-needle biopsy of the lung mass was unrevealing. Cytological examination of sputum specimens showed findings consistent with non-small-cell lung carcinoma. Nineteen weeks post-presentation, the patient reported low-back pain. Within 24 hours after the onset of low-back pain, he developed focal neurological deficits, and a magnetic resonance imaging (MRI) of the skull and spine showed osteolytic lesions of the temporal bones bilaterally, multiple vertebral lesions, and lesions of sacrum and iliac bones. Radiotherapy of the lumbar spine and pelvis was given. Sternal aspiration was performed. Cytological examination revealed P. jiroveci. In conclusion, we describe a rare case of disseminated P. jiroveci infection in an HIV-seropositive patient, with multiple skeletal lesions, especially in the skull and in vertebrae region, and concomitant non-small-cell lung cancer, with a very poor prognosis.

Key Words: SPINAL • VERTEBRAL • BONE • IMMUNOSUPPRESSED • HIV • PNEUMOCYSTIS CARINII

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?