2022, Number 2
Severe pneumocystis pneumonia treated with chloroquine and clindamycin in an AIDS patient allergic to sulfonamides
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ABSTRACTBackground: Pneumocystis jirovecii pneumonia is a frequent cause of respiratory distress in patients with HIV infection, about 90% of cases occur in those with a CD4+ count ‹ 200 cells/mm3. Incidence has decreased severely with antiretroviral treatment, but mortality continues to be high: around 12%. The clinical manifestations are variable, from a normal physical examination in mild cases to dyspnea, crackles and tachycardia in more severe cases. Most characteristic laboratory abnormality is hypoxemia, and lactate dehydrogenase › 500 U/L is frequently observed, although it is not pathognomonic.
Clinical case: A 23-year-old male patient, with a student occupation, HIV positive, allergic to sulfonamides, who was diagnosed with Pneumocystis jirovecii pneumonia and received treatment with chloroquine and clindamycin. The administration of prednisone concomitant to the administration of antibiotics was necessary.
Conclusiones: The antibiotic treatment of choice is trimethoprim/sulfamethoxazole at a dose of 15-20 mg/kg/day based on trimethoprim, for a period of 21 days; in moderate to severe cases, steroids must be used, prednisone is of choice for 21 days as well. For patients with sulfonamide allergies, there are alternative treatments, such as primaquine 30 mg/day PO plus clindamycin 600 mg qid also for 21 days.
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