Digital necrosis and disseminated Pneumocystis carinii infection after aerosolized pentamidine prophylaxis
Davey, R.T.; Margolis, D.; Kleiner, D.; Deyton, L.; Travis, W.
Annals of Internal Medicine 111(8): 681-682
1989
ISSN/ISBN: 0003-4819 PMID: 2802423 Document Number: 326973
The case of a 26-year-old male who had recurrent episodes of P. carinii pneumonia secondary to infection with HIV (probably acquired through a blood transfusion given during the course of treatment of a testicular germ cell malignancy, 4 years previously) is reported from the USA. After the 4th episode of P. carinii infection, he was started on biweekly prophylaxis with 150 mg of inhaled pentamidine. About 6 months later, he developed necrosis of the toes on both feet, followed by systemic disease and death 2 weeks later. At autopsy, foci of P. carinii were found in the lungs (more within the arterioles and capillaries than in the alveolar spaces), brain, heart, thyroid, adrenals, kidney, spleen, liver and other gastrointestinal organs. A 26-year-old HIV-seropositive man, who had previously been given aerosolized pentamidine for episodes of Pneumocystis carinii infection, developed necrosis and gangrene of the first 4 toes of each foot. Autopsy revealed widespread P. carinii infection. The primary cause of the severe vasospasm appeared to be the presence of extensive thromboemboli containing P. carinii within arterioles and capillaries. This case adds to the at least 26 other cases of extrapulmonary pneumocystosis reported in the literature. .W. FitzSimons.