article = {COR-2020-7-102}
title = {Pneumocystis jirovecii Pneumonia in a Patient with Lung Adenocarcinoma and EGFR Mutation Treated with Afatinib During the Coronavirus Pandemic 2019}
journal = {Clinical Oncology and Research}
year = {2020}
issn = {2613-4942}
doi = {http://dx.doi.org/10.31487/j.COR.2020.07.02}
url = {https://www.sciencerepository.org/pneumocystis-jirovecii-pneumonia-in-a-patient-with-lung-adenocarcinoma_COR-2020-7-102 
author = {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,}
keywords = {Lung cancer, COVID-19 pneumonia, Pneumocystis jirovecii infection}
abstract ={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.
}