Pneumocystis jirovecii pneumonia presenting as a solitary pulmonary granuloma due to unclean continuous positive airway pressure equipment: a case report

Abstract

Continuous positive airway pressure (CPAP) therapy can spread infections if the equipment is not cleaned properly. We report a case of Pneumocystis jirovecii pneumonia likely spread by unclean CPAP equipment and accessories. A 48-year-old man with severe obstructive sleep apnea was using CPAP equipment that had never been cleaned for 5 years. He experienced intermittent mild fever for 6 weeks. His chest images showed a solitary pulmonary granuloma. Pneumocystis jirovecii was identified from the bronchoalveolar fluid, the CPAP mask, and the air tubing. The fever subsided immediately after changing to a clean CPAP device. We prescribed sulfamethoxazole 400 mg and trimethoprim 80 mg twice daily for 1 month. Three months later, the pulmonary granuloma disappeared, and P. jirovecii was absent in the bronchoalveolar fluid. Poorly cleaned CPAP devices could harbor P. jirovecii and spread pulmonary infection in immunocompetent persons. Appropriate cleaning of CPAP equipment is essential to minimize infection risk.