Pneumocystis Pneumonia in a Non-HIV Patient With Advanced Liver Cirrhosis and No History of Immunosuppression: A Case Report

TL;DR

A non-HIV patient with advanced liver cirrhosis developed Pneumocystis pneumonia, showing that severe liver disease alone can be a risk factor for this infection.

Contribution

This case report highlights PCP in a non-HIV patient with advanced liver cirrhosis and no immunosuppression, an underreported scenario.

Findings

PCP was diagnosed in a non-HIV patient with advanced liver cirrhosis and no immunosuppressive therapy.

The patient's condition worsened with a secondary Candida bloodstream infection, leading to death.

The case emphasizes the need to consider PCP in liver cirrhosis patients with respiratory symptoms.

Abstract

Pneumocystis pneumonia (PCP) is a critical opportunistic infection, typically seen in immunocompromised individuals. While its association with HIV is well known, there is a growing recognition of PCP in non-HIV patients, often linked to immunosuppressive therapy. However, cases of PCP in patients with liver cirrhosis and without iatrogenic immunosuppression remain underreported. We describe the case of a 72-year-old male patient with advanced liver cirrhosis (Child-Pugh score 12) secondary to metabolic dysfunction-associated steatohepatitis. He presented with fever and cough and was diagnosed with PCP based on characteristic imaging findings, elevated serum β-D-glucan, and a positive polymerase chain reaction test for Pneumocystis jirovecii in his sputum. Notably, he had no history of immunosuppressant use or HIV infection. Despite initial improvement in his respiratory condition with trimethoprim-sulfamethoxazole and corticosteroids, his hospital course was complicated by subsequent Candida bloodstream infection, ultimately leading to his death. This case highlights that advanced liver cirrhosis alone can constitute a significant risk factor for PCP and underscores the poor prognosis often associated with this condition. It emphasizes the importance of considering PCP in the differential diagnosis for patients with liver cirrhosis presenting with respiratory failure.

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