Acquired Immunodeficiency from Maternal Chemotherapy and Severe Primary Pneumocystis Infection in an Infant
Table 2
Schema of events from maternal diagnosis of B-cell lymphoma, the birth of the infant, and readmission for Pneumocystis pneumonia with the associated management.
Events
Period
Treatment
Pregnancy
(i) 2nd trimester
(i) Diagnosed B-cell lymphoma
(ii) 17–33 weeks’ gestation
(ii) Received 6 cycles of R-CHOP
Birth
(i) At birth (35 weeks’ gestation)
(i) Admitted to the special care unit
(ii) D7
(ii) Discharged home
Readmission
(i) 11 weeks (corrected 6 weeks)
(i) Presented to the peripheral hospital
(ii) D1
(ii) High flow nasal cannula, IV ampicillin and gentamicin
(a) Changed to IV cefotaxime (D1–8)
(iii) D3
(iii) Noninvasive ventilation
(a) IV azithromycin added (D3–D5)
Pneumocystis jirovecii diagnosis and management
(i) D4
(i) Pneumocystis jirovecii positive on NPA; PO co-trimoxazole started
(ii) D8
(ii) Changed to IV co-trimoxazole
(iii) D9
(iii) Intubated, transferred to tertiary hospital
(iv) D11
(iv) High-frequency oscillation, commenced 2nd line PCP treatment
Further management
(i) D15
(i) Commenced VV-ECMO
(ii) D16
(ii) Bronchoscopy—positive for Pneumocystis jirovecii
