Abstract

Pneumocystis jerovici pneumonia (PJP) is a well recognized complication in certain groups of immunocompromised patients generally with underlying T lymphocyte disorders. We report a case of PJP in an immunocompetent adult. The 42-year-old male patient presented with fever, cough, bloody sputum, chest pain and increasing dyspnea. Chest radiography revealed bilateral diffuse infiltrations in the middle and basal zones. He was unresponsive to a combination of broad spectrum antibiotics. The diagnosis of PJP was made by presence of P. jerovici in direct immunofluorescence examination of bronchial lavages. He did not have a history of systemic illness, corticosteroid use or any risk factors for HIV infection and HIV serology was negative. The immunoglobulin levels were within normal ranges. CD4/CD8 ratio was 1.07, but CD4 count was normal. The patient recovered promptly after prescription of co-trimoxazole therapy; chest radiography and arterial blood gas tensions improved dramatically. We conclude that P. jerovici may cause severe community acquired pneumonia even in the absence of a clinically evident immunodeficient state.