Pulmonary Opportunistic Infections in A Lung Cancer Patient Treated with Inhaled Corticosteroid

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Opportunistic pulmonary infections, including Pneumocystis jiroveci pneumonia (PcP) and cytomegalovirus (CMV) pneumonitis are uncommon in human immunodeficiency virus (HIV)-seronegative persons who are immunocompromised on account of hematological malignancy, immunosuppressive therapy, or a primary immunodeficiency. PcP remains an infrequent event among patients with solid tumor malignancies. Here we report a 63 year-old stage IIB lung cancer patient who developed fatal PcP and CMV pneumonitis after treated with inhaled steroid, radiotherapy and gefitinib. She had not been treated with chemotherapy; and the radiotherapy she received had not caused obvious leucopenia. In the absence of obvious immunosuppressive effects resulting from chemotherapy or radiotherapy, we suggest that the use of inhaled corticosteroid might increase the susceptibility of pulmonary opportunistic infections in potentially immunocompromised hosts, i.e., COLD or lung cancer patients, even in the absence of marked leucopenia. Susceptible patients who are treated with inhaled corticosteroid developing rapid evolution of dyspnea, substernal chest tightness, nonproductive cough and fever should be considered as suffering from PcP and should be treated accordingly until proven otherwise. Coinfection with other opportunistic pathogens should be identified and treated concurrently. Following up lymphocyte or CD4 count and prophylaxis measures are advocated in selected patients.