Double Infection in a Patient with Chronic GVHD Post Allogeneic Transplant: “Hickam's Dictum” Trumps “Occam's Razor”!—A Case Report with Review of Literature

Fen Saj; Vendoti Nitheesha Reddy; Smita Kayal; Biswajit Dubashi; Rakesh Singh; Noyal Mariya Joseph; Prasanth Ganesan

doi:10.1055/s-0042-1748166

Indian Journal of Medical and Paediatric Oncology, Table of Contents

CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0042-1748166

Case Report with Review of Literature

Double Infection in a Patient with Chronic GVHD Post Allogeneic Transplant: “Hickam's Dictum” Trumps “Occam's Razor”!—A Case Report with Review of Literature

Authors

Fen Saj

¹Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
Vendoti Nitheesha Reddy

²Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
Smita Kayal

¹Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
Biswajit Dubashi

¹Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
Rakesh Singh

³Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
Noyal Mariya Joseph

³Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
Prasanth Ganesan

¹Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India

Abstract

Double pneumonia with Pneumocystis jirovecii (PCP) and Mycobacterium tuberculosis (MTB) has been reported in patients with acquired immune deficiency syndrome. A similar immune-suppressed state exists in allogeneic transplant survivors treated for graft-versus-host disease (GVHD). The clinical features and imaging findings could be quite similar in both the etiologies. Reaching a timely diagnosis and initiation of appropriate therapy is essential to prevent complications. We report a patient who had concurrent PCP and MTB pneumonia while on treatment for chronic GVHD. We describe the diagnostic challenge, the treatment, and outcome of this patient. We intend to sensitize physicians to consider more than one etiology in this subset of patients.

Keywords

Pneumocystis jirovecii - mycobacterium tuberculosis - allogeneic transplant - stem cell transplantation - double infection - graft-versus-host disease - ruxolitinib

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References

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