0
Postgraduate Education Corner: PULMONARY AND CRITICAL CARE PEARLS |

A 41-Year-Old Woman With AIDS and Recurrent Pneumonia

Eunpi Cho, MD; Brian T. Garibaldi, MD; David N. Hager, MD, PhD
Author and Funding Information

From the School of Medicine (Dr Cho), and the Division of Pulmonary and Critical Care Medicine (Drs Garibaldi and Hager), Johns Hopkins University, Baltimore, MD.

Correspondence to: Brian T. Garibaldi, MD, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, 1830 East Monument St, 5th Floor, Baltimore, MD 21287; e-mail: bgaribal@jhmi.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):224-227. doi:10.1378/chest.09-1192
Text Size: A A A
Published online

Extract

A 41-year-old woman with AIDS (CD4 count 39 cells/mm3) was transferred to the medical ICU for worsening hypoxemic respiratory failure. She had been hospitalized 6 weeks earlier reporting several days of dry cough, shortness of breath, fevers, chills, and diarrhea. A chest radiograph performed on admission revealed bilateral infiltrates (Fig 1A). BAL identified Pneumocystis jiroveci and cytomegalovirus (CMV) shell antigen. Because of a documented sulfamethoxazole-trimethoprim (SMX-TMP) allergy (rash), she was initially treated with clindamycin and primaquine in addition to prednisone. After 5 days of treatment without any clinical improvement, she was cautiously switched from clindamycin and primaquine to SMX-TMP without complications. Her antiretroviral therapy was resumed 2 weeks later. Her clinical condition improved and by the third week of SMX-TMP therapy, a slow prednisone taper was initiated. However, 1 week later the patient developed tachycardia, recurrent dyspnea, and fever. These symptoms progressed with an increasing oxygen requirement, intractable cough, and confusion. She ultimately required intubation and transfer to the ICU. Her medications at that time included SMX-TMP, prednisone, vancomycin, piperacillin-tazobactam, azithromycin, amphotericin-B, abacavir-lamivudine, and lopinavir-ritonavir.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

Suggested Readings

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543