Pneumocystis pneumonia (PCP) is an opportunistic infection well recognized in patients with profound T cell immunodeficiency, especially in patients with AIDS. This infection is also a life-threatening complication seen during immunosuppressive chemotherapy for cancer or organ transplantation, so it is important to make an early diagnosis and start treatment. We present three cases of PCP developing during chemotherapy for solid malignancies.Case reports
Case 1: A 50-year-old female received a first-line chemotherapy of gemcitabine–docetaxel (GT therapy) for leiomyosarcoma. After three cycles of GT therapy, she was admitted for a non-productive cough and high fever. Her chest radiograph and CT showed diffuse ground-glass bilateral opacities. SpO2 was 90% (room air). Serum β-D-glucan was 66.7 pg/ml. PCR of PCP by using BAL specimens was positive. We diagnosed PCP infection. Case 2: A 70-year-old female received gemcitabine (GEM) monotherapy as a first-line treatment of a pancreas cancer. After two cycles of GEM therapy, she developed dyspnea and a fever of 38°C. Her chest radiograph and CT showed diffuse ground-glass bilateral opacities. SpO2 was 92% (room air). Serum β-D-glucan was 40.8 pg/ml. We diagnosed PCP infection on the basis of these findings. Case 3: A 64-year-old female received neo-adjuvant chemotherapy with 5-fluoropyrimidine, epirubicin and cyclophosphamide (FEC therapy) for a breast cancer. After two cycles of FEC therapy, she was admitted for febrile neutropenia. Although neutropenia was recovered, she developed exertional dyspnea and a non-productive cough with continuous high fever. Her chest CT showed diffuse ground-glass bilateral opacities. SpO2 was 90% (room air). Serum β-D-glucan was 39.5 pg/ml. We diagnosed PCP infection on the basis of these findings. These patients were immediately treated with trimethoprim–sulfamethoxazole (ST) and corticosteroid. The infiltrations and diffuse ground-glass opacities on their chest radiographs improved and they got well.Conclusion
We should be careful of not only drug-induced interstitial pneumonia and febrile neutropenia but also PCP during chemotherapy for solid malignancies.