Academic Journal
Coinfection of Pneumocystis jirovecii and Aspergillus fumigatus in the lung: A case report.
| Title: | Coinfection of Pneumocystis jirovecii and Aspergillus fumigatus in the lung: A case report. |
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| Authors: | He MH; Department of Pulmonary and Critical Care Medicine, Yidu Central Hospital of Weifang, Qingzhou, China., Chen XL; Department of Hematology, Yidu Central Hospital of Weifang, Qingzhou, China., Feng BT; Department of Hematology, Yidu Central Hospital of Weifang, Qingzhou, China. |
| Source: | Medicine [Medicine (Baltimore)] 2026 Sep 18; Vol. 105 (38), pp. e50705. |
| Publication Type: | Journal Article; Case Reports |
| Language: | English |
| Journal Info: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 2985248R Publication Model: Print Cited Medium: Internet ISSN: 1536-5964 (Electronic) Linking ISSN: 00257974 NLM ISO Abbreviation: Medicine (Baltimore) Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins |
| MeSH Terms: | Pneumocystis carinii*/isolation & purification , Aspergillus fumigatus*/isolation & purification , Coinfection*/drug therapy , Coinfection*/microbiology , Coinfection*/diagnosis , Pneumonia, Pneumocystis*/drug therapy , Pneumonia, Pneumocystis*/diagnosis , Pulmonary Aspergillosis*/drug therapy, Antifungal Agents/therapeutic use ; Voriconazole/therapeutic use ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use ; Lymphoma, Mantle-Cell/drug therapy ; Bronchoalveolar Lavage Fluid/microbiology ; Humans ; Male ; Aged ; Immunocompromised Host |
| Abstract: | Rationale: Coinfection with Pneumocystis jirovecii and Aspergillus fumigatus in immunocompromised patients carries high mortality. More importantly, paradoxical clinical and radiological responses during treatment remain poorly understood. Patient Concerns: A 66-year-old male with mantle cell lymphoma who had received prolonged corticosteroid therapy after suspected rituximab-associated lung injury presented with progressive pulmonary symptoms. Diagnoses: Concurrent pulmonary infection with P jirovecii and A fumigatus was confirmed by bronchoalveolar lavage combined with metagenomic next-generation sequencing. Interventions: The patient was treated with trimethoprim-sulfamethoxazole and voriconazole. Outcomes: Clinical symptoms improved markedly; however, chest imaging showed paradoxical progression, possibly reflecting an immune reconstitution inflammatory syndrome-like inflammatory response. Lessons: bronchoalveolar lavage combined with metagenomic next-generation sequencing enables rapid diagnosis of concurrent opportunistic pulmonary infections. Paradoxical radiographic worsening despite clinical improvement may suggest an immune reconstitution inflammatory syndrome-like inflammatory response, although persistent or progressive infection cannot be excluded. (Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, LLC.) |
| Competing Interests: | The authors have no conflicts of interest to declare. |
| References: | Kim YH, Kim JY, Kim DH, et al. Pneumocystis pneumonia occurrence and prophylaxis duration in kidney transplant recipients according to perioperative treatment with rituximab. BMC Nephrol. 2020;21:93. Luo W, Lin X, Chen Y, Luo W, Zhang H. Metagenomic next-generation sequencing for accurate diagnosis of Pneumocystis jirovecii pneumonia: a comparative study with traditional methods. Infect Drug Resist. 2024;17:2965–74. Yi HM, Xu CH, Yang DL, et al. Clinical characteristics and CT findings of Pneumocystis jirovecii pneumonia in 46 cases with hematological diseases. Zhonghua Xue Ye Xue Za Zhi. 2023;44:118–23. Hatzl S, Geiger C, Kriegl L, et al. Pulmonary coinfection of Pneumocystis jirovecii and aspergillus species. Open Forum Infect Dis. 2025;12:ofaf018. Baumann S, Reinwald M, Haghi D, Hofmann WK, Buchheidt D. Coinfection of Pneumocystis jirovecii and invasive pulmonary aspergillosis in an immunocompromised patient: a diagnostic challenge. Onkologie. 2013;36:582–4. Jia H, Liu H, Tu M, et al. Diagnostic efficacy of metagenomic next generation sequencing in bronchoalveolar lavage fluid for proven invasive pulmonary aspergillosis. Front Cell Infect Microbiol. 2023;13:1223576. Chou CW, Lin FC, Tsai HC, Chang SC. The importance of pro-inflammatory and anti-inflammatory cytokines in Pneumocystis jirovecii pneumonia. Med Mycol. 2013;51:704–12. Heldt S, Eigl S, Prattes J, et al. Levels of interleukin (IL)-6 and IL-8 are elevated in serum and bronchoalveolar lavage fluid of haematological patients with invasive pulmonary aspergillosis. Mycoses. 2017;60:818–25. Gonçalves SM, Lagrou K, Rodrigues CS, et al. Evaluation of bronchoalveolar lavage fluid cytokines as biomarkers for invasive pulmonary aspergillosis in at-risk patients. Front Microbiol. 2017;8:2362. Bosamiya SS. The immune reconstitution inflammatory syndrome. Indian J Dermatol. 2011;56:476–9. Sun HY, Singh N. Immune reconstitution inflammatory syndrome in non-HIV immunocompromised patients. Curr Opin Infect Dis. 2009;22:394–402. Yingkui J, Liping Z. Immune reconstitution inflammatory syndrome associated with invasive pulmonary fungal disease. Chin J Tuberculosis Respiratory Diseases. 2026;49:500–2. Vaselli NM, Salaveria K, Winearls J, Garnham K. Pneumocystis jirovecii pneumonia – immune reconstitution inflammatory syndrome: a review of published cases. HIV Med. 2025;26:839–48. Pulsipher AM, Ham K, Vikram HR, Henry KJ, Thompson ER, Gotway MB. Pneumocystis jirovecii pneumonia: typical and atypical CT findings in a large cohort of immunocompromised patients with and without HIV. Radiol Cardiothorac Imaging. 2026;8:e250171. |
| Grant Information: | 2025YX098 Weifang Science and Technology Development Program (Medical Category) |
| Contributed Indexing: | Keywords: IRIS; coinfection |
| Substance Nomenclature: | 0 (Antifungal Agents) JFU09I87TR (Voriconazole) 8064-90-2 (Trimethoprim, Sulfamethoxazole Drug Combination) |
| Entry Date(s): | Date Created: 20260919 Date Completed: 20260919 Latest Revision: 20260924 |
| Update Code: | 20260924 |
| PubMed Central ID: | PMC13592971 |
| DOI: | 10.1097/MD.0000000000050705 |
| PMID: | 42760695 |
| Database: | MEDLINE |
| ISSN: | 1536-5964 |
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| DOI: | 10.1097/MD.0000000000050705 |