SHM Converge Scientific Abstract ePoster Gallery-Neck Abscess in Hiv Patient: Atypical Extrapulmonary Presentation of Pneumocystis Jirovecii

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A 36-year-old man with newly diagnosed HIV presented to Infectious Disease clinic with a painful, enlarging left supraclavicular neck lump that had been present for four months and became more painful over the prior two months. He denied fever, chills, cough, or shortness of breath. His history was notable for HIV diagnosed on 7/15/21, prior opportunistic and sexually transmitted infections, including cryptococcal meningitis/fungemia, syphilis treated with benzathine penicillin, and suspected genital herpes/oral thrush. He was taking Biktarvy and prophylaxis for Pneumocystis jirovecii pneumonia (PJP), though Bactrim had been changed to atovaquone temporarily because of AKI.<br /><br />On exam, he was afebrile and hemodynamically stable, with a tender 2 cm left supraclavicular lymph node. Current HIV control was good, with viral load 20 and CD4 count 322.<br /><br />Imaging showed a left superior mediastinal and supraclavicular mass/lymphadenopathy with low attenuation and surrounding fat stranding, plus multiple pulmonary nodules. Ultrasound-guided FNA of the supraclavicular mass revealed abscess formation, and GMS staining demonstrated Pneumocystis organisms. Fungal, AFB, and malignancy studies were negative.<br /><br />He was diagnosed with an atypical extrapulmonary Pneumocystis jirovecii infection presenting as a neck abscess. He was treated with high-dose Bactrim (2 double-strength tablets every 8 hours) for six weeks, later switched to atovaquone because of severe nausea. Follow-up CT showed interval decrease in the abscess size.<br /><br />The case highlights that P. jirovecii infection, usually limited to the lungs, can rarely present extrapulmonarily in HIV patients as lymph node, skin, or soft tissue disease, and tissue diagnosis is essential.

Asset Subtitle

Roop Parlapalli

Meta Tag

Author List Akshaykumar Vachhani, Prasanthi Limgala, Roop Parlapalli, Thulashie Sivarajah

Category Clinical Vignettes

Concept Pneumocystis jirovecii

Concept Trimethoprim-sulfamethoxazole

Concept Extrapulmonary Disease

Concept HIV

Concept Fine Needle Aspiration

Distinguished Non-Finalist

Presenter Organization Geisinger

Presenting Author Roop Parlapalli

Track Adult

Keywords

HIV

Pneumocystis jirovecii

extrapulmonary infection

neck abscess

supraclavicular lymphadenopathy

mediastinal mass

lymph node FNA

GMS staining

pulmonary nodules

Bactrim treatment

Pneumocystis jirovecii

Trimethoprim-sulfamethoxazole

Extrapulmonary Disease

HIV

Fine Needle Aspiration