Late Pneumocystis Jirovecii Pneumonia Often Misdiagnosed
1Transplant Institute, Henry Ford Health System, Detroit, MI, 2Transplant Institute, Henry Ford Health System, Ann Arbor, MI
Meeting: 2020 American Transplant Congress
Abstract number: A-205
Keywords: Immunosuppression, Infection, Kidney transplantation, Pneumonia
Session Information
Session Name: Poster Session A: Kidney Infectious Excluding Polyoma & Viral Hepatitis
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Since 2/2018, we have identified 60 transplant recipients presenting with late PCR confirmed Pneumocystis jirovecii (PJP). Of this initial group, 17 kidney transplant recipients presented with PJP at a median of 1505 days post-transplantation. In this abstract, we studied the clinical characteristics of these patients.
*Methods: Retrospective chart review.
*Results: The demographic variables at the time of diagnosis of PJP are presented in the table.”
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Several observations characterize this population: the diagnosis of PJP was suspected on admission in 4 patients (23%); 77% of patients were misdiagnosed with community acquired pneumonia, and as average treatment with sulfas was delayed a mean 7 days. Of these patients, 1 was diagnosed on readmission, 1 was diagnosed post-mortem. Chest-X showed presented with bilateral ground glass infiltrates in 99% of cases. The 2 most common symptoms at presentation were low grade fever and dyspnea with severe hypoxemia and 41% of patients required mechanical ventilations resulting in a mean length of stay of 32 days. A noticeable commonality in these patients was the treatment pre-ESKD with immunosuppressants for glomerular disease or vasculitis. Leukopenia at presentation portended a poor prognosis resulting in death. Seventy percent of patients had concomitant viral infection (CMV, BKV, HSV),1 patient had 3 different fungal infections, and 2 patients were diagnosed with PTLD after the diagnosis of PJP. In regards to transplant outcomes, 3 grafts failed and 2 patients died.
*Conclusions: In summary, late PJP occurs in kidney transplant recipients and presents with a severe phenotype. It is often misdiagnosed due to the misconception that this disease presents early in the post-transplant course after discontinuation of sulfa prophylaxis. Although PJP did not have a seasonal presentation, 1 case was documented to be the results of nosocomial transmission.
To cite this abstract in AMA style:
Samaniego M, Prashar R, Khoury N, Patel A. Late Pneumocystis Jirovecii Pneumonia Often Misdiagnosed [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/late-pneumocystis-jirovecii-pneumonia-often-misdiagnosed/. Accessed November 21, 2024.« Back to 2020 American Transplant Congress