A Case of Nephrotic Syndrome With Pneumocystis Jirovecii Infection

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.