A Case of Nephrotic Syndrome With Pneumocystis Jirovecii Infection

Authors : Merve ERÇELİK, Gül AKIN, Kürşad ÖNEÇ, Fuat AYTEKİN, Özlem ATAOĞLU, Mehmet Fatih ELVERİŞLİ

Pages : 325-328

Doi:10.18521/ktd.423555

View : 18 | Download : 9

Publication Date : 2019-06-28

Article Type : Other Papers

Abstract :Pneumocystis jirovecii pneumonia (commonly called Pneumocystis pneumonia or PCP) is an opportunistic infection that occurs in immunocompromised individuals.  26 year-old male patient admitted to nephrology department for hypervolemic hyponatremia and consulted to our clinic because  desaturation developed. He has been diagnosed with collapsing glomerulonephritis (GN) and he was using cyclosporine and prednisolone. Postero-anterior chest X-ray  showed that; left cardiodiaphragmatic sinus was blunt. In the arterial blood gas, Ph:7,42  PO2:53 mmHg PCO2:35,4 mmHg, HCO3:23,6 mEql/L. The the alveolar arterial gradient was elevated (52,75). Antibiotic and because of hypervolemia diuretic therapy was recommended to the patient. After ten days the patient's hypoxia deepened.Repeated chest X-ray showed bilateral perihilar   heterogeneous opacity.  Flexible bronchoscopy was performed. Pneumocystis jirovecii was detected in lavage culture. The patient treated with Trimethoprim- Sulfamethoxazole (TMP-SMZ) (3 x 7.5 mg / kg) dose. Hypoxemia improved on the 7th day of treatment and the patient was discharged. TMP-SMZ treatment was completed in 21 days. Pneumocystis developing secondary to cyclosporin toxicity Jirovecii pneumonia is a rare case.
Keywords : Pneumocystis Jirovecii, Collapsing glomerulonephritis, Nephrotic syndrome