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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr0620103111.
Published online Oct 22, 2010. doi:  10.1136/bcr.06.2010.3111
PMCID: PMC3029578
Reminder of important clinical lesson
Late presentation of Pneumocystis jiroveci pneumonia after cardiac transplantation
L R Craker
Department of Anaesthesia, Burton Hospitals NHS Foundation Trust, Burton-on-Trent, UK
Correspondence to L R Craker, lloydcraker/at/
We report the case of a 64-year-old man who had received a heart transplant 9 years previously and was on long-term immunosuppression. He was referred to the intensive care unit of our district general hospital with acute respiratory distress and was diagnosed with community-acquired pneumonia. He was treated with antimicrobials, whose spectrum was extended empirically to cover Pneumocystis jiroveci, and respiratory support was provided with continuous positive airway pressure (CPAP). PCR analysis subsequently confirmed a diagnosis of pneumocystis pneumonia (PCP). Despite appropriate therapy the patient unfortunately died 8 days after admission to the unit. To the author's knowledge, this is the first report in the literature of such a late presentation of PCP after cardiac transplantation. We discuss current diagnostic and treatment strategies for PCP.
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