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A Case of Pneumonia Caused by Pneumocystis jirovecii Resistant to Trimethoprim-Sulfamethoxazole
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Case Report

A Case of Pneumonia Caused by Pneumocystis jirovecii Resistant to Trimethoprim-Sulfamethoxazole

Sang Min Lee1, Yong Kyun Cho2, Yon Mi Sung3, Dong Hae Chung4, Sung Hwan Jeong1, Jeong-Woong Park1, Sang Pyo Lee1,*
The Korean Journal of Parasitology 2015;53(3):321-327.
Published online: June 30, 2015

1Division of Pulmonology and Allergy, Gachon University Gil Medical Center, Incheon 405-760, Korea

2Division of Infection, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 405-760, Korea

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*Corresponding author (allergy21@hotmail.com)
• Received: November 20, 2014   • Revised: June 1, 2015   • Accepted: June 2, 2015

© 2015, Korean Society for Parasitology and Tropical Medicine

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A Case of Pneumonia Caused by Pneumocystis jirovecii Resistant to Trimethoprim-Sulfamethoxazole
Korean J Parasitol. 2015;53(3):321-327.   Published online June 30, 2015
DOI: https://doi.org/10.3347/kjp.2015.53.3.321
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A Case of Pneumonia Caused by Pneumocystis jirovecii Resistant to Trimethoprim-Sulfamethoxazole
Korean J Parasitol. 2015;53(3):321-327.   Published online June 30, 2015
DOI: https://doi.org/10.3347/kjp.2015.53.3.321
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A Case of Pneumonia Caused by Pneumocystis jirovecii Resistant to Trimethoprim-Sulfamethoxazole
Image Image Image
Fig. 1. Initial chest X-ray and follow-up chest X-rays after the initiation of treatment for Pneumocystis jirovecii pneumonia (PCP). (A) Initial chest X-ray showed streaky and fibrotic lesions in both lungs. (B) In the follow-up chest X-ray performed 12 days after the initiation of TMP-SMX treatment, the lesions were markedly improved. (C) In a follow-up chest X-ray carried out 29 days after the initiation of TMP-SMX treatment, streaky and fibrotic lesions in both lungs were aggravated. (D) In the follow-up chest X-rays, performed 21 days after changing the anti-PCP therapy from TMP-SMX to primaquine-clindamycin, the lesions were improved again.
Fig. 2. Initial chest CT revealed multifocal, peribronchial patchy ground-glass opacities in both lungs with septated cystic lesions (arrow) in the left upper lobe (A), and the right lower lobe (B). A follow-up chest CT revealed the aggravation of multifocal, peribronchial ground-glass opacity, and septated cystic lesions (arrows) in both upper lungs (C), and the newly appeared consolidation (arrow) in the left lower lobe (D).
Fig. 3. Photomicrography of Pneumocystis jirovecii pneumonia. (A) Hematoxylin and eosin staining shows eosinophilic frothy exudates in alveolar spaces accompanied by mild interstitial inflammation (H&E, ×200). (B) Grocott-Gomori’s methenamine silver (GMS) stain visualized many cystic- and trophic-form organisms (arrows) in alveolar exudate, consistent with Pneumocystis jirovecii infection (GMS, ×400).

Fig. 1.

Fig. 2.

Fig. 3.

A Case of Pneumonia Caused by Pneumocystis jirovecii Resistant to Trimethoprim-Sulfamethoxazole
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