Abstract Introduction Respiratory failure after lung resection can be due to postoperative complications or infection. The incidence of Pneumocystis Jirovecii pneumonia (PJP) is rare in immunocompetent patients with solid cancers who have not received chemotherapy. We report the case of a lung cancer patient who developed PJP after right lower lobe lobectomy and mediastinal lymph node dissection. Case 63-year-old female with history of hypertension and tobacco use underwent RLL lobectomy and mediastinal lymphadenectomy 1 week prior to admission. She subsequently presented with complaints of cough, shortness of breath and generalized weakness. Her CXR showed right hemithorax opacification. CT chest revealed postoperative volume loss and ground glass opacities in the right middle lobe. She was treated with broad spectrum antibiotics empirically for pneumonia without improvement in her respiratory symptoms. Bronchoalveolar lavage showed Pneumocystis Jirovecii on quantitative PCR. Her serum Beta D glucan was also positive. Her HIV testing was negative. She was initiated on trimethoprim-sulfamethoxazole and high dose steroids. She developed neuropsychiatric symptoms and steroids had to be discontinued. Repeat CXR showed persistent opacification of the right hemithorax, which raised concern for possible right middle lobe torsion. Repeat bronchoscopy revealed right sided mucus plugging only, and CXR improved after secretion clearance. She underwent tracheostomy due to prolonged ventilator dependence, and she was eventually discharged to LTAC for prolonged ventilator weaning. Discussion The incidence of PJP pneumonia in lung cancer patients has been related to risk factors such as chemoradiotherapy, metastasis, prior steroid treatment, and HIV infection. Few cases of PJP pneumonia have been globally reported in non-immunocompromised patients with lung cancer after surgical treatment alone. Conclusion PJP pneumonia should be suspected in this clinical scenario with associated risk factors when pulmonary infiltrates fail to improve with empiric antibiotic therapy alone. This abstract is funded by: None
Alvi et al. (Fri,) studied this question.