Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2015; 3(9): 843-847
Published online Sep 16, 2015. doi: 10.12998/wjcc.v3.i9.843
Do inhaled corticosteroids increase the risk of Pneumocystis pneumonia in people with lung cancer?
Sameh Msaad, Ilhem Yangui, Najla Bahloul, Narjes Abid, Makram Koubaa, Yosr Hentati, Mounir Ben Jemaa, Samy Kammoun
Sameh Msaad, Ilhem Yangui, Najla Bahloul, Narjes Abid, Samy Kammoun, Department of Respiratory Medicine, Hedi Chaker University Hospital, 3029 Sfax, Tunisia
Makram Koubaa, Mounir Ben Jemaa, Department of Infectious Diseases, Hedi Chaker University Hospital, 3029 Sfax, Tunisia
Yosr Hentati, Department of Radiology, Hedi Chaker University Hospital, 3029 Sfax, Tunisia
Author contributions: All authors contributed to this work.
Institutional review board statement: The study was reviewed and approved.
Informed consent statement: The patient is dead.
Data sharing statement: No conflict interest.
Open-Access: 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/
Correspondence to: Makram Koubaa, MD, Department of Infectious Diseases, Hedi Chaker University Hospital, Ain Street Km 0.5, 3029 Sfax, Tunisia. makram.koubaa@gmail.com
Telephone: +216-21-880402
Received: October 20, 2014
Peer-review started: October 21, 2014
First decision: December 12, 2014
Revised: April 15, 2015
Accepted: June 1, 2015
Article in press: June 2, 2015
Published online: September 16, 2015
Processing time: 330 Days and 16 Hours
Abstract

Pneumocystis pneumonia (PCP) is a life-threatening infection in immunocompromised patients. It is relatively uncommon in patients with lung cancer. We report a case of PCP in a 59-year-old man with a past medical history of chronic obstructive pulmonary disease treated with formoterol and a moderate daily dose of inhaled budesonide. He had also advanced stage non-small lung cancer treated with concurrent chemo-radiation with a cisplatin-etoposide containing regimen. The diagnosis of PCP was suspected based on the context of rapidly increasing dyspnea, lymphopenia and the imaging findings. Polymerase chain reaction testing on an induced sputum specimen was positive for Pneumocystis jirovecii. The patient was treated with oral trimethoprim-sulfamethoxazole and systemic corticotherapy and had showed clinical and radiological improvement. Six months after the PCP diagnosis, he developed a malignant pleural effusion and expired on hospice care. Through this case, we remind the importance of screening for PCP in lung cancer patients under chemotherapeutic regimens and with increasing dyspnea. In addition, we alert to the fact that long-term inhaled corticosteroids may be a risk factor for PCP in patients with lung cancer. Despite intensive treatment, the mortality of PCP remains high, hence the importance of chemoprophylaxis should be considered.

Keywords: Pneumocystis jiroveci; Lung neoplasms; Pneumonia; Inhaled corticosteroids; Prophylaxis

Core tip:Pneumocystis pneumonia (PCP) is relatively uncommon in patients with lung cancer. We report a case of PCP in a 59-year-old man with a past medical history of chronic obstructive pulmonary disease treated with formoterol and a moderate daily dose of inhaled budesonide. He had also advanced stage non-small lung cancer treated with concurrent chemo-radiation. This report attempts to alert for the importance of PCP screening in lung cancer patients under chemotherapeutic regimens and with increasing dyspnea. It also alerts to the role of long-term inhaled corticosteroids as a risk factor for PCP in patients with lung cancer.