# A Case of Pneumocystis jirovecii Pneumonia Requiring Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) Management in a Young Patient With Aortic Inflammation Syndrome

## TL;DR

A young woman with a weakened immune system due to medication developed severe Pneumocystis pneumonia and was successfully treated with VV-ECMO.

## Contribution

This case report highlights the use of VV-ECMO in a young non-HIV PCP patient with no other organ failure.

## Key findings

- The patient's respiratory failure improved after 20 days of VV-ECMO without major complications.
- VV-ECMO should be considered for non-HIV PCP patients with life-threatening respiratory failure.
- Young patients with no other organ failure may benefit from VV-ECMO despite immunodeficiency.

## Abstract

Pneumocystis jirovecii pneumonia (PCP) occurs in immunocompromised patients. It is classified into cases in human immunodeficiency virus (HIV)-positive (HIV-PCP) patients and HIV-negative (non-HIV-PCP) patients. Non-HIV-PCP is associated with particularly poor prognosis, and case reports using veno-venous extracorporeal membrane oxygenation (VV-ECMO) are scarce.

This case report describes a 25-year-old female patient with a history of taking multiple immunosuppressive medications who was diagnosed with PCP. She received antibiotic treatment, but her hypoxemia worsened, and she was admitted to the intensive care unit. Non-invasive respiratory therapy failed to improve hypoxemia, so endotracheal intubation and mechanical ventilation were initiated. However, adequate oxygenation was not achieved. Despite immunodeficiency, the patient was young and had no other organ failure. Therefore, the initiation of VV-ECMO was decided upon. After 20 days of VV-ECMO management, there were no major complications, and respiratory abnormalities improved. In cases of non-HIV-PCP presenting with life-threatening respiratory failure, VV-ECMO initiation should be considered.