key: cord-1042777-32kd9vva
authors: Mang, Sebastian; Kaddu-Mulindwa, Dominic; Metz, Carlos; Becker, André; Seiler, Frederik; Smola, Sigrun; Maßmann, Alexander; Becker, Sören L; Papan, Cihan; Bals, Robert; Lepper, Philipp M; Danziger, Guy
title: Pneumocystis Jirovecii Pneumonia and SARS-CoV-2 Co-Infection in newly diagnosed HIV-1 infection
date: 2020-07-01
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa906
sha: ede74171071a8c0b3577c9befad9a4d58e6f50ec
doc_id: 1042777
cord_uid: 32kd9vva

nan

M a n u s c r i p t 2 DEAR EDITOR -It was recently suggested that excess risk of respiratory failure due to COVID-19 may be lower than expected for people living with human immunodeficiency virus (PLWH) [1] . We report the case of a 52-year-old male from our intensive care unit (ICU) who developed acute respiratory failure due to Covid-19, Pneumocystis jirovecii Pneumonia (PJP) and newly diagnosed HIV, stage 3 [2] . Diagnosis of SARS-CoV-2 disguised the presence of PJP.

On the 25th of April 2020, a 52-year-old gentleman presented at the emergency unit of a nearby hospital with fever of 40°C, cough, and shortness of breath. He deteriorated soon after, requiring endotracheal intubation. SARS-CoV-2 was detected from tracheal aspirate.

In addition, bronchial aspirate samples grew with Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter dijkshoorniae. Blood cultures grew Vancomycin-resistant Enterococcus faecium and Staphylococcus epidermidis. Hence, a broad antibiotic regimen containing meropenem and linezolid was initiated, yet the patient continued to have daily fevers up to 40°C without responding to antipyretics or antibiotics. He deteriorated further despite escalated pressure-controlled invasive ventilation and was finally transferred to our intensive care unit on 13 th May, 2020, for possible initiation of extracorporeal membrane oxygenation (ECMO).

For evaluation of pulmonary COVID-19 manifestation and in preparation for possible ECMO, computed tomography (CT) was performed on 13 th and 14 th May. Chest CT showed bilateral ground glass opacities, consolidations, and crazy-paving pattern typical for COVID-19 [3] , [4] . As a potential sign for subacute manifestation, airway changes, pleural changes, fibrosis, and nodules were present (Figure 1 Over the next two weeks, his state improved significantly. Noradrenaline administration could be terminated three days after initiation of trimethoprim-sulfamethoxazole. Antiretroviral therapy had no apparent side effects, especially creatinine clearance and liver function remained stable over the following weeks. CMV-copies declined to <450 U/mL two weeks after Ganciclovir was started on 14 th May. Under ART the viral load declined to 2,800 copies/mL (equaling 2.11 log units) on 25 th May, 2020. HIV-1 genotyping revealed no relevant drug resistances. After convalescence and ability to swallow reliably, ART was switched to a single tablet regime to maintain patient's compliance and to reduce the pill burden. A c c e p t e d M a n u s c r i p t 8 Figure 1 

Why Aren't People Living with HIV at Higher Risk for Developing Severe Coronavirus Disease 2019 (COVID-19)

Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. The Lancet Infectious Diseases

Coronavirus Disease 2019 (COVID-19) CT Findings: A Systematic Review and Meta-analysis

The authors are grateful to our patient for giving his consent for publication. We would like to acknowledge all colleagues from our department as well as other departments and labs at A c c e p t e d M a n u s c r i p t