SHM Converge Scientific Abstract ePoster Gallery-Ah! Pjp: Pneumocystis Pneumonia in an Hiv Negative Patient With Alcoholic Hepatitis

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This case report describes a 28-year-old man with alcohol use disorder who developed severe alcoholic hepatitis and was treated with a prolonged prednisolone taper (40 mg daily for 28 days) without Pneumocystis jirovecii pneumonia (PJP) prophylaxis. One month later, he was readmitted with malaise, cough, worsening jaundice, and abdominal pain. Initial evaluation showed advanced liver dysfunction (MELD 3.0 score 27, bilirubin 32.7, INR 1.7) and early imaging with subtle ground-glass opacities but no clear consolidation. He was initially treated for presumed community-acquired pneumonia.<br /><br />Despite antibiotics, his respiratory status worsened with productive cough, fatigue, and hemoptysis. Repeat imaging showed progression of ground-glass opacities and consolidation, raising concern for an opportunistic infection. Workup revealed an elevated beta-D-glucan, while fungal serologies for PJP, histoplasma, and blastomycosis were negative. He developed respiratory failure, required ICU transfer, and bronchoscopy with bronchoalveolar lavage confirmed PJP. Unfortunately, he continued to deteriorate and died.<br /><br />The report highlights that PJP can occur in non-HIV immunocompromised patients, particularly those receiving chronic corticosteroids, even when prophylaxis is not routinely mandated. Typical PJP symptoms include low-grade fever, dry cough, and progressive dyspnea, but presentation may be rapid in HIV-negative patients. Diagnosis is usually made by BAL, though yield is lower in non-HIV patients due to lower fungal burden. The authors emphasize that opportunistic infections should be considered in steroid-treated patients with respiratory symptoms, and that the threshold for PJP prophylaxis in non-HIV patients remains unclear.

Asset Subtitle

Omar T. Ellaicy

Meta Tag

Author List Gareth Voss, Omar T. Ellaicy

Category Clinical Vignettes

Concept Acute Alcoholic Hepatitis

Concept Pneumocystis jirovecii pneumonia

Concept Corticosteroids

Concept Pneumocystis jirovecii prophylaxis

Concept Chronic corticosteroid use

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author Omar T. Ellaicy

Track Adult

Keywords

Pneumocystis jirovecii pneumonia

PJP prophylaxis

alcoholic hepatitis

prednisolone taper

corticosteroid immunosuppression

non-HIV immunocompromised

ground-glass opacities

bronchoalveolar lavage

beta-D-glucan

respiratory failure

Acute Alcoholic Hepatitis

Pneumocystis jirovecii pneumonia

Corticosteroids

Pneumocystis jirovecii prophylaxis

Chronic corticosteroid use