CASE PRESENTATION PARAPNEUMONIC PLEURAL EFFUSION WITH PNEUMOCYSTIS JIROVECII

Pneumocystis jirovecii is an opportunistic fungus p redominantly found in sputum or broncho-alveolar lavage from patients with pneumonia caused by this microorganism, its evidence in pleural effusion bei ng rarely described in the literature. We report a case of ri ght parapneumonic pleural effusion in a 79 years ol d female patient, from urban area, with a history of chronic bronchitis, but no proven history of immunosuppres sion. The patient presented with low grade fever, chest pain and dyspnea. Clinical and radiological investigatio ns revealed increased amounts of pleural fluid. It has been established a therapy with ceftazidime and ge ntamicin and after three days without any clinical improveme nt it has been performed pleurotomy for pleural cav ity drainage. There were examined three samples of pleu ral fluid in microbiology laboratory from different days which showed no growth in usual culture media (bloo d-agar, MacConkey, Sabouraud) after 72 hours. At microscopic examination cystic forms and rarely tro phic forms of Pneumocystis jirovecii were observed in two of the three samples, in smears stained with methyl ene blue and Giemsa. In addition to mentioned treat ment it has been introduced trimethoprim-sulfamethoxazole, the patient's clinical evolution was favorable deve loping a slow process of organizing a right lateral-basal pa hipleuritis. The patient was sent home with an impr oved state and survey indication by family physician.