TY - JOUR
AR - COR-2020-7-102
TI - Pneumocystis jirovecii Pneumonia in a Patient with Lung Adenocarcinoma and EGFR Mutation Treated with Afatinib During the Coronavirus Pandemic 2019
AU - Agnese , Montanino
AU - Giovanna , Esposito
AU - Giuliano , Palumbo
AU - Anna , Manzo
AU - Vincenzo , Sforza
AU - Raffaele , Costanzo
AU - Claudia , Sandomenico
AU - Carmine , Picone
AU - Carmine , La Manna
AU - Rossella , De Cecio
AU - Gerardo , Botti
AU - Paolo , Muto
AU - Giuseppe , Totaro
AU - Nicola , Normanno
AU - Alessandro, Morabito
JO - Clinical Oncology and Research
PY - 2020
DA - Wed 14, Oct 2020
SN - 2613-4942
DO - http://dx.doi.org/10.31487/j.COR.2020.07.02
UR - https://www.sciencerepository.org/pneumocystis-jirovecii-pneumonia-in-a-patient-with-lung-adenocarcinoma_COR-2020-7-102 
KW - Lung cancer, COVID-19 pneumonia, Pneumocystis jirovecii infection
AB - 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.