Abstract Background Pneumocystis jirovecii pneumonia (PJP) remains a life-threatening opportunistic infection in patients with advanced HIV. The role of venovenous-extracorporeal membrane oxygenation (VV-ECMO) in this population remains poorly defined. Methods We report two patients with newly diagnosed HIV and PJP-associated acute respiratory distress syndrome who required prolonged VV-ECMO support. Case Reports Case-1 involved a 54-year-old woman (CD4 12, HIV viral load 455,000 copies/mL) who was diagnosed with PJP via bronchoalveolar lavage (BAL) and treated with trimethoprim-sulfamethoxazole (TMP-SMX). Her respiratory status deteriorated, requiring intubation on hospital day 7 and ECMO cannulation on day 11. During hospitalization, she developed a pneumothorax and superimposed Acinetobacter baumannii pneumonia. Despite initial improvement, her course was complicated by refractory shock and multiorgan failure. She was transitioned to comfort-care on ECMO day 69. Case-2 was a 49-year-old man (CD4 76, HIV viral load 429,000 copies/mL) with hypoxemic respiratory failure who was intubated on hospital day 5. After failing neuromuscular blockade, nitric oxide, and proning, he was cannulated for ECMO on day 13. BAL PCR confirmed P. jirovecii (15,600 copies/mL). Bilateral pneumothoraces, VRE bacteremia, and dialysis-requiring kidney injury complicated his course. He was eventually decannulated on ECMO day 71 and discharged to a rehabilitation center on day 109 for ventilator weaning. Conclusion ECMO is not routinely recommended for HIV-associated respiratory failure; these cases underscore that with careful patient selection and management, prolonged ECMO support may lead to survival in selected cases. Conversely, complications such as IRIS, refractory shock, and organ failure, as in Case-1, may preclude recovery despite aggressive intervention. This abstract is funded by: None
Ghosh et al. (Fri,) studied this question.