Co-Infection of COVID-19 and Pneumocystosis Following Rituximab Infusion—A Case Report

Michelle Dakowitz,Oktawia Mazanowska,Justyna Korus,Magdalena Krajewska,Dorota Kamińska

doi:10.3390/transplantology3010008

Abstract

Immunocompromised patients with respiratory viral infections are at increased risk of fungal superinfections, including Pneumocystosis. Within the scope of the COVID-19 pandemic, Pneumocystis jirovecii co-infections are being increasingly reported. Differential diagnosis often creates a dilemma, due to multiple overlapping clinical and radiographic features. Awareness of fungal co-infections in the context of the COVID-19 pandemic is crucial to initiate prophylactic measures, especially in high-risk individuals. We report the second case of Pneumocystis jirovecii pneumonia and COVID-19 co-infection in a renal transplant recipient in Poland.

Highlights

Immunocompromised patients frequently develop infection caused by the pathogen Pneumocystis jirovecii (PJP), leading to the development of pneumonia, which can be lifethreatening [1]
We report a case of a renal transplant recipient, who developed PJP with concomitant COVID-19 infection
[42], but developed co-infection of PJP and COVID-19, which resulted in fatal outcome

Summary

Introduction

Immunocompromised patients frequently develop infection caused by the pathogen Pneumocystis jirovecii (PJP), leading to the development of pneumonia, which can be lifethreatening [1]. COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is a disease that attacks the respiratory system It spreads through droplet particles excreted by the patient during coughing or sneezing [4]. Hospital in Wrocław, Poland, because of elevated CRP levels (250.4 mg/L) found in the Transplant Outpatient Clinic He presented in moderately severe condition, with fever (38–39 ◦ C), cough, dyspnoea and myalgia. The patient developed extreme respiratory insufficiency and hypoxemia, despite ventilation with 100% oxygen. Despite recruitment manoeuvres and ventilation in the prone position, the state of the patient deteriorated with severe respiratory acidosis (pCO2-92 mmHg and pH-6.963), increase in d-dimer to 1.2 μg/mL and procalcitonin to 1.3 ng/mL in laboratory studies and refractory hypotension (BP 70/40 mmHg), in spite of vasopressor infusion and renal replacement therapy.

Discussion

Findings

Conclusions

Conclusions and concurrent