Cheng QW, Shen HL, Dong ZH, Zhang QQ, Wang YF, Yan J, Wang YS, Zhang NG. Pneumocystis jirovecii diagnosed by next-generation sequencing of bronchoscopic alveolar lavage fluid: A case report and review of literature. World J Clin Cases 2023; 11(4): 866-873 [PMID: 36818625 DOI: 10.12998/wjcc.v11.i4.866]
Corresponding Author of This Article
Ning-Gang Zhang, MD, Associate Chief Physician, Department of Gastrointestinal Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, No. 3 Zhigong Xincun Street, Xinhualing District, Taiyuan 030013, Shanxi Province, China. zng1120@163.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Qing-Wei Cheng, Hong-Li Shen, Zhi-Hui Dong, Qian-Qian Zhang, Ya-Fen Wang, Jin Yan, Department of Oncology, The Sixth Division Hospital, Xinjiang Production and Construction Corps, Wujiaqu 831300, Xinjiang Uygur Autonomous Regions, China
Yu-Sheng Wang, Ning-Gang Zhang, Department of Gastrointestinal Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, Shanxi Province, China
Author contributions: Cheng QW and Shen HL contributed to the manuscript writing; Dong ZH, Yan J, Zhang QQ, and Wang YS followed the patient during treatment; Wang YS and Zhang NG revised the manuscript; and all authors granted final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ning-Gang Zhang, MD, Associate Chief Physician, Department of Gastrointestinal Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, No. 3 Zhigong Xincun Street, Xinhualing District, Taiyuan 030013, Shanxi Province, China. zng1120@163.com
Received: September 19, 2022 Peer-review started: September 19, 2022 First decision: December 13, 2022 Revised: December 22, 2022 Accepted: January 9, 2023 Article in press: January 9, 2023 Published online: February 6, 2023 Processing time: 139 Days and 14 Hours
Abstract
BACKGROUND
The advent of molecular targeted agents and immune checkpoint inhibitors has greatly improved the treatment of advanced renal cell carcinoma (RCC), thus significantly improving patient survival. The incidence of rare drug-related adverse events has gained increased attention.
CASE SUMMARY
We report a patient with advanced RCC treated with multiple lines of molecular targeted agents and immune checkpoint inhibitors, who developed a pulmonary infection after treatment with everolimus in combination with lenvatinib. Determining the pathogenic organism was difficult, but it was eventually identified as Pneumocystis jirovecii by next-generation sequencing (NGS) of bronchoscopic alveolar lavage fluid (BALF) and successfully treated with trimethoprim-sulfamethoxazole.
CONCLUSION
Rare pulmonary infections caused by molecular targeted agents are not uncommon in clinical practice, but their diagnosis is difficult. Evaluating BALF with NGS is a good method for rapid diagnosis of such infections.
Core Tip: The application of molecular targeted agents and immune checkpoint inhibitors have greatly improved the prognosis of advanced renal cell carcinoma (RCC). We report a patient with advanced RCC treated with multiple lines of molecular targeted agents, who developed a Pneumocystis jirovecii pneumonia after treatment with everolimus in combination with lenvatinib. The pathogenic organism was identified by next-generation sequencing (NGS) of bronchoscopic alveolar lavage fluid (BALF) and successfully treated with trimethoprim-sulfamethoxazole. Evaluating BALF with NGS technology might be used to detect pathogens and determine the correct treatment plan for patients with rare infections caused by the use of molecular targeted agents.
