Positive Pneumocystis jirovecii Sputum PCR Results with Negative Bronchoscopic PCR Results in Suspected Pneumocystis Pneumonia

Table 1

Clinical characteristics of patients with positive sputum PCP-PCR testing and negative BAL/bronchial washing PCP-PCR results.

Reason for the immunocompromised state	Clinical course	Prior PCP prophylaxis	Response to PCP treatment	60-day mortality
None	New-onset mild respiratory failure later diagnosed with small cell lung cancer	None	Did not receive treatment	Living
History of renal transplant currently undergoing treatment for PTLD	Presented with dry cough and bilateral infiltrates on radiograph. No respiratory distress	None	Clinical improvement	Living
Metastatic neuroendocrine cancer on carboplatin and gemcitabine	Presented with significant respiratory failure (A-a gradient 350 mmHg) and bilateral upper lobe infiltrates	None	No clinical improvement	Died within 24 hours
None	Presented with cough and mild respiratory distress but progressed to overt respiratory failure requiring mechanical ventilation. Treatment initiated for PCP but developed thrombocytopenia and renal failure	None	No clinical improvement	Died within 2 weeks
Multifocal lung adenocarcinoma and steroid-dependent COPD	Presented with severe respiratory failure (A-a gradient 210 mmHg) requiring mechanical ventilation. Treated for PCP but continued to decline. Died secondary to sepsis from necrotizing pneumonia	Trimethoprim-sulfamethoxazole	No clinical improvement	Died within 2 weeks
Chronic lymphocytic leukemia with a remote history of alemtuzumab/rituximab	Presented with respiratory failure (A-a gradient 93 mmHg) and bilateral infiltrates on radiograph	None	Clinical improvement	Living
T-cell lymphoblastic lymphoma s/p 1 cycle of hyper-CVAD	Presented with hypoxic respiratory failure (A-a gradient 43 mmHg) and left mid/lower lung infiltrates. Improved with PCP treatment but was concurrently diagnosed with disseminated HSV and treated with acyclovir	None	Clinical improvement	Living
Follicular lymphoma s/p bone marrow transplant	Dry cough with evidence of pneumonitis on follow-up PET scan. No respiratory distress	None	Clinical improvement	Living
Multiple myeloma s/p bone marrow transplant	Presented with hypoxic respiratory failure and diffuse bilateral infiltrates on chest radiograph.	Trimethoprim-sulfamethoxazole	Clinical improvement	Living
Dermatomyositis on high-dose prednisone and methotrexate	Presented with severe hypoxic respiratory failure (A-a gradient 93 mmHg) and bilateral perihilar infiltrates on radiograph	None	Clinical improvement	Living

PCP = Pneumocystis jirovecii pneumonia; PCR = polymerase chain reaction; BAL = bronchoalveolar lavage; PTLD = posttransplant lymphoproliferative disorder; COPD = chronic obstructive pulmonary disease; s/p = status-post; hyper-CVAD = hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone.