Pneumocystis jiroveci pneumonitis in an infant

Abstract

ES is a 7-month-old female born to a non-consanguineous Caucasian couple at 35 weeks of gestation following a pregnancy that was complicated by Maternal Non-Hodgkin's Lymphoma requiring R-CHOP (Chemotherapy) from 17 to 35 weeks antenatally. At 12 weeks of age ES progressively deteriorated following a respiratory illness requiring invasive respiratory support. Initial investigations showed marked lymphopenia of 1.5 x 10^9/L and a search for opportunistic organisms revealed elevated Pneumocystis Jiroveci counts in her BAL. Following this she was started on a combination of Primaquine, Lincomycin and Bactrim treatment. Apart from the lymphopenia, her IgG was noted to be extremely low at <1.0 g/L. There were concerns of a primary immunodeficiency, however this was confounded by the possibility of a secondary immunodeficiency due to the use of maternal R-CHOP antenatally. Her recent thymic emigrants were noted to be 53% suggestive of adequate output from the thymus and her PHA was also normal suggestive of adequately functioning T cells. Recovery of lymphocyte counts to 7.2 x 109/L and IgG to 3.2 g/L post supportive management including intravenous immunoglobulin over the ensuing months confirmed the likelihood of a secondary immunodeficiency in her presentation. She is currently on low flow oxygen and her immunoglobulin levels have stabilized without ongoing IVIG, as her own production of immunoglobulins takes over. This case illustrates the importance of monitoring of babies born to mothers on chemotherapy and consideration of supportive management which may include antimicrobial prophylaxis and intravenous immunoglobulins during the first 6-12 months of life.L6317768592020-05-25 <br />