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VV-ECMO combined with prone position ventilation in the treatment of Pneumocystis jirovecii pneumonia: A case report
INTRODUCTION: Pneumocystis jirovecii pneumonia (PJP) occurs in immunocompromised hosts. It is classified as PJP with human immunodeficiency virus (HIV) infection (HIV-PJP) and PJP without HIV infection (non-HIV PJP). Compared with HIV-PJP, non-HIV PJP is more likely to develop rapidly into respirato...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8735805/ https://www.ncbi.nlm.nih.gov/pubmed/35029898 http://dx.doi.org/10.1097/MD.0000000000028482 |
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author | Jia, Lijing Zhang, Zhiyang Bai, Yinxiang Du, Quansheng |
author_facet | Jia, Lijing Zhang, Zhiyang Bai, Yinxiang Du, Quansheng |
author_sort | Jia, Lijing |
collection | PubMed |
description | INTRODUCTION: Pneumocystis jirovecii pneumonia (PJP) occurs in immunocompromised hosts. It is classified as PJP with human immunodeficiency virus (HIV) infection (HIV-PJP) and PJP without HIV infection (non-HIV PJP). Compared with HIV-PJP, non-HIV PJP is more likely to develop rapidly into respiratory failure, with difficult diagnosis and high mortality. PATIENT CONCERNS: A 46-year-old male with membranous nephropathy was treated with oral corticosteroids and tacrolimus. He was admitted to our hospital for fever and dyspnea which developed 4 days ago. Laboratory data revealed that leukocytes were 10.99 × 10(9)/L, neutrophils 87.7%, lymphocytes 9.6%, C-reactive protein 252.92 mg/L, New coronavirus nucleic acid detection negative. CT scan of chest revealed ground-glass opacity in both lungs. He was admitted to the respiratory department of our hospital, and then transferred to ICU because of his critical condition. DIAGNOSIS: High throughput gene detection of pathogenic microorganisms in alveolar lavage fluid showed that the detection sequence of Pneumocystis yersiniae increased significantly. The serum HIV-antibody was negative. Therefore, the patient was diagnosed as non-HIV PJP. INTERVENTIONS: After admission, the patient was assisted by noninvasive ventilator and treated with compound trimethoprim-sulfamethoxazole (SMX-TMP) and caspofungin. The patient's condition continued to deteriorate, and then underwent endotracheal intubation and veno-venous extracorporeal membrane oxygenation (VV-ECMO) combined with prone position ventilation until the lung lesion improved. OUTCOMES: VV-ECMO was stopped on day 12, tracheal intubation was removed after 2 days. The patient was transferred to the respiratory department on day 15, discharged after 12 days without complications. Two months later, the follow-up showed that the patient was in good condition. CONCLUSION: VV-ECMO combined with prone position ventilation could be a useful choice for respiratory assistance in non-HIV PJP patients. |
format | Online Article Text |
id | pubmed-8735805 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-87358052022-01-11 VV-ECMO combined with prone position ventilation in the treatment of Pneumocystis jirovecii pneumonia: A case report Jia, Lijing Zhang, Zhiyang Bai, Yinxiang Du, Quansheng Medicine (Baltimore) 3900 INTRODUCTION: Pneumocystis jirovecii pneumonia (PJP) occurs in immunocompromised hosts. It is classified as PJP with human immunodeficiency virus (HIV) infection (HIV-PJP) and PJP without HIV infection (non-HIV PJP). Compared with HIV-PJP, non-HIV PJP is more likely to develop rapidly into respiratory failure, with difficult diagnosis and high mortality. PATIENT CONCERNS: A 46-year-old male with membranous nephropathy was treated with oral corticosteroids and tacrolimus. He was admitted to our hospital for fever and dyspnea which developed 4 days ago. Laboratory data revealed that leukocytes were 10.99 × 10(9)/L, neutrophils 87.7%, lymphocytes 9.6%, C-reactive protein 252.92 mg/L, New coronavirus nucleic acid detection negative. CT scan of chest revealed ground-glass opacity in both lungs. He was admitted to the respiratory department of our hospital, and then transferred to ICU because of his critical condition. DIAGNOSIS: High throughput gene detection of pathogenic microorganisms in alveolar lavage fluid showed that the detection sequence of Pneumocystis yersiniae increased significantly. The serum HIV-antibody was negative. Therefore, the patient was diagnosed as non-HIV PJP. INTERVENTIONS: After admission, the patient was assisted by noninvasive ventilator and treated with compound trimethoprim-sulfamethoxazole (SMX-TMP) and caspofungin. The patient's condition continued to deteriorate, and then underwent endotracheal intubation and veno-venous extracorporeal membrane oxygenation (VV-ECMO) combined with prone position ventilation until the lung lesion improved. OUTCOMES: VV-ECMO was stopped on day 12, tracheal intubation was removed after 2 days. The patient was transferred to the respiratory department on day 15, discharged after 12 days without complications. Two months later, the follow-up showed that the patient was in good condition. CONCLUSION: VV-ECMO combined with prone position ventilation could be a useful choice for respiratory assistance in non-HIV PJP patients. Lippincott Williams & Wilkins 2022-01-07 /pmc/articles/PMC8735805/ /pubmed/35029898 http://dx.doi.org/10.1097/MD.0000000000028482 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) |
spellingShingle | 3900 Jia, Lijing Zhang, Zhiyang Bai, Yinxiang Du, Quansheng VV-ECMO combined with prone position ventilation in the treatment of Pneumocystis jirovecii pneumonia: A case report |
title | VV-ECMO combined with prone position ventilation in the treatment of Pneumocystis jirovecii pneumonia: A case report |
title_full | VV-ECMO combined with prone position ventilation in the treatment of Pneumocystis jirovecii pneumonia: A case report |
title_fullStr | VV-ECMO combined with prone position ventilation in the treatment of Pneumocystis jirovecii pneumonia: A case report |
title_full_unstemmed | VV-ECMO combined with prone position ventilation in the treatment of Pneumocystis jirovecii pneumonia: A case report |
title_short | VV-ECMO combined with prone position ventilation in the treatment of Pneumocystis jirovecii pneumonia: A case report |
title_sort | vv-ecmo combined with prone position ventilation in the treatment of pneumocystis jirovecii pneumonia: a case report |
topic | 3900 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8735805/ https://www.ncbi.nlm.nih.gov/pubmed/35029898 http://dx.doi.org/10.1097/MD.0000000000028482 |
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