Chest Infections |

Transbronchial Biopsy Still Has a Role in the Diagnosis of Pneumocystis Pneumonia - Even in HIV Infected Patients FREE TO VIEW

Firas Elmufdi, MD; Abbie Begnaud, MD; Vipul Patel, MD
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University of Florida, Gainesville, FL

Chest. 2013;144(4_MeetingAbstracts):189A. doi:10.1378/chest.1704803
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SESSION TITLE: Infectious Disease Case Report Posters III

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Pneumocystis pneumonia (PCP) is the most frequently found opportunistic infection in HIV-infected and otherwise immune compromised patients. Because it is a treatable infection, rapid and accurate diagnosis is mandatory. Over the past thirty years, recommendations no longer emphasize obtaining lung tissue by transbronchial biopsy (TBBx). We present a case of PCP requiring TBBx for diagnosis in a patient with advanced HIV infection

CASE PRESENTATION: 49 year-old woman diagnosed with HIV infection 15 years before presentation. She was treated with highly active antiretroviral therapy (HAART) for 10 years. She was not compliant with medication for last 5 years. Patient presented with subacute onset of dyspnea, cough and fever. Physical examination showed mild respiratory distress and diffuse inspiratory crackles. Her CD4 count was 5 cells/µl. Arterial blood gas analyses showed significant decrease in PaO2. Chest radiograph revealed bilateral airspace disease. CT pulmonary angiogram showed no pulmonary embolus and confirmed diffuse bilateral alveolar infiltrates. Fungal stain on induced sputum sample showed no organism. Bronchoscopy showed no endo-bronchial lesion. Cytology of bronchoalveolar lavage (BAL) revealed no organisms. TBBx showed pneumocystis jioroveci organism present in intra alveolar space. Patient was treated for PCP with sulfamethoxazole and trimethoprim combination and cortico-steroids for 21 days. She had significant improvement in clinical condition

DISCUSSION: The sensitivity of BAL in detecting PCP exceeds 85%. It is not clear whether a combined approach of BAL and TBBx could improve this result. Several authors have reported that the yield of TBBx alone is significantly lower than that of BAL in the diagnosis of PCP, with a sensitivity ranging between 36% and 86%1. We propose along with BAL, simultaneous TBBx should be performed to increase yield in the diagnosis of PCP

CONCLUSIONS: Our case shows the utility of TBBx for diagnosis of PCP, even in patients with HIV infection. TBBx should be performed unless specifically contraindicated

Reference #1: 1.Remco S. Djamin et al., Diagnosis of Pneumocystis carinii Pneumonia in HIV-Positive Patients Bronchoalveolar Lavage vs. Bronchial Brushing. Acta Cytologica, 1998; 42(4): 933-938

DISCLOSURE: The following authors have nothing to disclose: Firas Elmufdi, Abbie Begnaud, Vipul Patel

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