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26 February 2020 : Case report  Italy

Successful Extracorporeal Membrane Oxygenation Treatment in an Acquired Immune Deficiency Syndrome (AIDS) Patient with Acute Respiratory Distress Syndrome (ARDS) Complicating Pneumocystis jirovecii Pneumonia: A Challenging Case

Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Clinical situation which can not be reproduced for ethical reasons

Benedetto Maurizio Celesia1AE*, Andrea Marino1E, Savino Borracino2BE, Antonio F. Arcadipane3BF, Grazia Pantò4BF, Maria Gussio1BEF, Salvatore Coniglio2BE, Alfio Pennisi5BF, Bruno Cacopardo1AEF, Giovanna Panarello3BF

DOI: 10.12659/AJCR.919570

Am J Case Rep 2020; 21:e919570

Abstract

BACKGROUND: Patients with HIV infection tend to have poor intensive care unit (ICU) outcomes; however, survival in the modern combination antiretroviral therapy (cART) era has markedly improved, but Pneumocystis jirovecii pneumonia (PJP) still remains a preeminent cause of respiratory failure in AIDS patients. Extracorporeal membrane oxygenation (ECMO) is an adapted cardiopulmonary bypass circuit for temporary life support for patients not responding to conventional treatment.

CASE REPORT: A 43-year-old male HIV “late presenter” was admitted to our hospital for fever and dyspnea. A chest CT scan revealed bilateral ground-glass opacities. Empiric antibiotic treatment and cART were started. The emergence of ARDS due to PJP dictated urgent veno-venous (VV) ECMO placement. One week later, radiologic findings and respiratory function had improved and the patient was started on a weaning trial from ECMO and removed 12 days after placement.

CONCLUSIONS: Acute respiratory distress syndrome (ARDS) is a potentially reversible clinical syndrome with a high mortality rate. ECMO is a rescue therapy allowing lung recovery during acute processes and should be considered an adequate treatment option in HIV+ patients with respiratory failure. ECMO should be considered a useful and adequate treatment option in AIDS patients who have a high risk of dying from respiratory failure.

Keywords: AIDS-Related Opportunistic Infections, Extracorporeal Circulation, Respiratory Distress Syndrome, Adult, Pneumocystis jirovecii, Acquired Immunodeficiency Syndrome, Adult, Extracorporeal Membrane Oxygenation, Immunocompromised Host, Male, Pneumocystis carinii, Pneumonia, Pneumocystis

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923