PCP Pneumonia 1112012 HPI Presentation 5 year old

PCP Pneumonia 1_11_2012

HPI - Presentation • 5 year old male with B-cell ALL – Fever – Hypoxemia – Bilateral infiltrates on CXR – Recently completed induction chemotherapy

Past Medical History • B-cell ALL – Diagnosed 11/2011 – On maintenance therapy with methotrexate and 6 -MP • Autoimmune neutropenia – Diagnosed at age 2 – No history of opportunistic infections – 1 prior PNA • Mild intermittent asthma

Course of Illness • 12/23 – Low-grade fevers after port placement • 12/29 – Started maintenance chemotherapy – CXR for mild hypoxemia • Non-specific perihilar pattern • Started on Bactrim prophylaxis

Course of Illness • 12/30 – Fevers to 101 -102 – Received dose of Levofloxacin in ER • 12/31 – Persistent fevers to 104 – CXR • bilateral reticulonodular intersitial markings

Chest CT

• Exam – 92% BBO 2 • Sats mid 80’s on room air – Tachypnic with mild retractions – Coarse BS bilaterally – but good air entry with no wheeze or crackles • Labs – WBC 11 • 89 P, 8 L

Flex bronchoscopy • • Normal anatomy Minimal tracheomalacia Scant thin, clear secretions BAL – positive for PCP on DFA – Bacterial, fungal, mycobacterial and viral studies negative

Hospital course • Intubated in OR after bronch for worsening respiratory distress – Tachypnic to 100’s and unable to oxygenate • Treatment – IV Bactrim – Solumedrol

Hospital course • Intubated for one week • Significantly improved