Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has changed the focus of healthcare and become a public health challenge around the world. The coinfection of SARS-CoV-2 with other microorganisms, including fungi, can cause difficult diagnosis and a worse prognosis. Pneumocystis jirovecii pneumonia (PJP) is a common opportunistic infection in human immunodeficiency virus (HIV) patients. However, sometimes the diagnosis is late presented after PJP finding on chest X-ray. We report a 24-year-old man with COVID-19 and PJP. Reverse transcriptase-polymerase chain reaction showed positive for SARS-CoV-2. HIV diagnosis was late presented after PJP finding on chest X-ray examination. HIV serology was positive with an absolute CD4+ count was 16 cells/mm3. He was treated with remdesivir IV, methylprednisolone IV, heparin, and cefoperazone-sulbactam IV. He was discharged after being admitted for 25 days. HIV treatment was started in outpatient services. Radiological diagnostic to diagnose concurrent COVID-19 and PJP pneumonia are important, especially in the setting where microscopic examination of sputum or Bronchoalveolar Lavage Fluid (BALF) is not available, or because BAL and sputum induction are aerosol-generating procedures that potentially increase the risk of COVID-19 transmission. HIV testing in COVID-19 patients was also should be considered as part of directed screening in patients presenting with features of PJP, especially for those with unknown HIV status. The determination of an appropriate corticosteroid dose is important to treat both COVID-19 and PJP with severe clinical features. Proper diagnosis and treatment co-infections are urgently needed in this current pandemic to reduce morbidity and mortality.
Highlights
A current global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly causing varying degrees of illness and become a public health challenge all over the world [1,2,3]
Radiological diagnostic to diagnose concurrent COVID-19 and Pneumocystis jirovecii pneumonia (PJP) pneumonia are important, especially in the setting where microscopic examination of sputum or Bronchoalveolar Lavage Fluid (BALF) is not available, or because BAL and sputum induction are aerosol-generating procedures that potentially increase the risk of COVID-19 transmission
human immunodeficiency virus (HIV) testing in COVID-19 patients was should be considered as part of directed screening in patients presenting with features of PJP, especially for those with unknown HIV status
Summary
A current global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly causing varying degrees of illness and become a public health challenge all over the world [1,2,3] Comorbidities such as hypertension, diabetes mellitus, obesity, cardiovascular disease, cerebrovascular disease, respiratory disease, kidney disease, and malignancy were reported as risk factors for more severe disease and worse prognosis [4,5,6], while many studies reported different results about the seriousness and outcomes of COVID-19 in patients with human immunodeficiency virus (HIV) infection, compared to the general population [3,7,8]. Some people are unaware they are infected with HIV because symptoms might not show for many years, HIV diagnosis was found at the late stage of infection along with PJP diagnosis [9,10]
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