Martínez-Hernández L, López-Enríquez C, Piedras-Hernández A, Salinas-Herrera VI, Galván-Salazar G

Idioma: Español
Referencias bibliográficas: 33
Paginas: 280-287
Archivo PDF: 496.38 Kb.

RESUMEN

Antecedentes: La neumonía por Pneumocystis jirovecii (PCP) es una infección oportunista potencialmente fatal en pacientes inmunosuprimidos. La insuficiencia respiratoria aguda con requerimientos de ventilación mecánica y alto riesgo de muerte ocurre con más frecuencia que en pacientes con VIH.
Caso clínico: Paciente femenina de 66 años, con antecedente de cáncer de mama triple negativo, contra el que recibió quimioterapia durante 12 semanas y radioterapia. Ingresó por padecer durante un mes disnea progresiva, tos productiva y fiebre. A su llegada a urgencias se encontró saturando al 75% al aire ambiente; los estudios de laboratorio mostraron DHL elevada. La radiografía de tórax no mostró alteraciones y la tomografía de tórax evidenció infiltrados intersticiales y patrón en vidrio despulido bilateral. Se inició tratamiento contra neumonía adquirida en la comunidad con ceftriaxona, claritromicina, trimetoprim/sulfametoxazol y prednisona. La broncoscopia evidenció quistes en forma de semiluna en la tinción de plata de Grocott correspondientes a P. jirovecii, con PCR de P. jirovecii positiva, con lo que se estableció el diagnóstico de neumonía por P. jirovecii. La paciente falleció tres semanas posteriores a su ingreso hospitalario a pesar del tratamiento óptimo.
Conclusiones: Este caso ejemplifica la evolución característica con alta mortalidad de pacientes inmunosuprimidos sin VIH que cursan con neumonía por P. jirovecii.

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