Board Review: Pneumocystis Pneumonia
35 year old male presents to your emergency department with fever, cough, chest pain. On chart review you see that the patient has a history of AIDS with a CD4 count of 100 and poor compliance with medication. You suspect Pneumocystis Pneumonia and start the appropriate treatment in the ED. At what alveolar-arterial gradient should you add steroids to treatment ? (scroll down for the answer)
The correct answer is A) >35 mmHg.
When treating pneumocystis pneumonia give steroids to patient with an alveolar-arterial gradient of >35mmHg.
Pneumocystis Pneumonia Pearls
- Caused by P. Jirovecii (previously P. Carinii)
- Approximately 70% of HIV infected patients acquire at least once during lifetime, have high clinical suspicion when CD4 count <200
- Often initial opportunistic infection that leads to diagnosis of AIDS
- Common clinical symptoms: fever, non-productive cough, worsening shortness of breath, fatigue
- Classic CXR: diffuse interstitial infiltrates
- Initial treatment: trimethoprim-sulfamethoxazole
- Give steroids to patients with a partial pressure of arterial oxygen of <70mmHg or an alveolar-arterial gradient of >35mmHg (usually oral prednisone starting at 40mg twice daily)
Stapczynski, J. Stephan,, and Judith E. Tintinalli. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: McGraw-Hill Education LLC., 2011.