Pneumocystispneumonia in an HIV-negative patient with no overt risk factors on presentation: Fig. 1—

Abstract

To the Editors : Pneumocystis pneumonia (PCP) is a potentially life-threatening opportunistic infection that can occur in HIV-positive and HIV-negative individuals. The most significant risk factor for PCP in HIV-negative patients is chemotherapy, with a median time from cancer diagnosis to the first episode of PCP of 2 yrs. We report here a case of PCP in an adult male who had no identifiable risk factors on presentation. 3 weeks after the first signs and symptoms of PCP, he manifested blast crisis of acute myeloid leukaemia. This would be the first case demonstrating PCP as the sole presentation of an underlying occult leukaemia. Our patient was a 55-yr-old homosexual male nonsmoker who presented with a 7-day history of progressive dyspnoea, dry cough, fever and chills. On examination, the patient's blood pressure was 130/70 mmHg, heart rate was 95 beats·min−1, respiratory rate 25 breaths·min−1, oxygen saturation 95% (3 L nasal oxygen), and temperature 37.9°C (100.2° F). The remainder of the physical examination was unremarkable. Chest radiograph (CXR) showed bilateral reticular markings with no pleural effusions (fig. 1a⇓). Pertinent laboratory results (normal values in parentheses) included a white blood cell (WBC) count of 8.1×10 …