Coinfection of Pneumocystis jirovecii and Aspergillus fumigatus in the lung: A case report.
Ming-Hong He, Xiang-Lei Chen, Bao-Tong Feng
✦ AI-curated · Sources linked
Case in brief
A 66-year-old male with mantle cell lymphoma and a history of corticosteroid therapy presented with worsening pulmonary symptoms. Diagnosis of concurrent Pneumocystis jirovecii and Aspergillus fumigatus infections was established through bronchoalveolar lavage and metagenomic next-generation sequencing. Treatment with trimethoprim-sulfamethoxazole and voriconazole led to significant clinical improvement, despite paradoxical progression on chest imaging.
What made this case unusual
The case highlights the paradoxical radiographic worsening of lung conditions despite clinical improvement, which may mimic immune reconstitution inflammatory syndrome.
Diagnostic / clinical pearl
Bronchoalveolar lavage combined with metagenomic next-generation sequencing is effective for rapid diagnosis of concurrent opportunistic pulmonary infections in immunocompromised patients.
Why it matters
Understanding the potential for paradoxical imaging findings during treatment is crucial for managing expectations and guiding further evaluation in similar cases.