Pneumocystis jirovecii Pneumonia in a Patient with Lung Adenocarcinoma and EGFR Mutation Treated with Afatinib During the Coronavirus Pandemic 2019

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Author Info

Agnese Montanino Giovanna Esposito Giuliano Palumbo Anna Manzo Vincenzo Sforza Raffaele Costanzo Claudia Sandomenico Carmine Picone Carmine La Manna Rossella De Cecio Gerardo Botti Paolo Muto Giuseppe Totaro Nicola Normanno Alessandro Morabito

Corresponding Author

Alessandro Morabito
Thoracic Medical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale – IRCCS, Napoli, Italy

A B S T R A C T

The novel coronavirus (SARS-CoV-2) or COVID-19 pneumonia is a new global pandemic that can be a challenge for the oncologists. Cancer patients are at high risk of contracting this infection and to develop severe respiratory complications. We present the case of a young patient with a metastatic EGFR positive lung adenocarcinoma in complete remission with afatinib therapy, who developed fever, dyspnea, dry cough, widespread pain and weakness during COVID-19 pandemic in Italy. The thorax computed tomography scan showed suspected pneumonia. Empiric antibiotic therapy was initiated without significant improvement in symptoms. The differential diagnosis included COVID-19 or other pneumonia, mycotic infection, disease progression or afatinib related pneumonia. A SARS-CoV-2 test on a nasopharyngeal swab was repeated twice, and it was negative. Tests for pneumobacteria, cytomegalovirus, tuberculosis bacteria and Legionella were also negative. We further performed a bronchoscopy with bronchoalveolar lavage, and a Pneumocystis jirovecii was microscopically identified. Treatment with trimethoprim-sulfamethoxazole was initiated, with regression of all symptoms. This case confirms the growing difficulties for oncologists during COVID-19 pandemic in the proper management of cancer patients, showing the challenges due to differential diagnoses. In this context, a multidisciplinary approach is crucial to define the best diagnostic and therapeutic strategy.

Article Info

Article Type

Case Report

Publication history

Received: Mon 08, Jun 2020
Accepted: Wed 24, Jun 2020
Published: Wed 14, Oct 2020

Copyright

© 2023 Alessandro Morabito. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.COR.2020.07.02