{
  "abstract": "Pneumocystis jirovecii pneumonia (PJP) is a severe and potentially life-threatening opportunistic infection in immunocompromised patients, especially those with hematologic malignancies. Although routine prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) has significantly reduced its incidence, breakthrough infections still occur, most commonly due to poor adherence to prophylactic therapy. This case report highlights the risks of non-adherence to PJP prophylaxis in adolescents and underscores the importance of early diagnostic suspicion and multidisciplinary management. A 15-year-old female patient with acute lymphoblastic leukemia presented during her seventh month of maintenance therapy (methotrexate and 6-mercaptopurine) in a compromised general condition with tachycardia, tachypnea, and hypoxemia, following a 24-hour history of fever and dry cough. Heteroanamnestic data revealed prolonged non-adherence to TMP-SMX prophylaxis. Imaging showed diffuse bilateral interstitial infiltrates on chest radiography and ground-glass opacities on high-resolution computed tomography (HRCT). PJP was confirmed via polymerase chain reaction (PCR) from bronchoalveolar lavage and a positive serum 1,3-β-D-glucan test. Treatment included intravenous TMP-SMX, corticosteroids, and high-flow nasal cannula oxygen therapy. The course was complicated by pancytopenia, likely secondary to TMP-SMX, and febrile neutropenia. A multidisciplinary approach, including social and psychiatric support, addressed non-adherence. The patient was discharged in good condition; maintenance therapy was continued, and prophylaxis was switched to monthly aerosolized pentamidine administered in the hospital setting. PJP prevention in pediatric oncology remains a significant challenge, as inconsistent adherence can rapidly lead to severe clinical deterioration. Our experience suggests that successful outcomes depend on addressing psychosocial barriers early. Transitioning to supervised, hospital-administered alternatives, such as aerosolized pentamidine, alongside multidisciplinary support, may help ensure adherence to prophylaxis in vulnerable oncology patients.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Pediatrics, Division of Hematology and Oncology, Clinical Hospital Center Rijeka, Rijeka, HRV.",
    "Department of Pediatrics, Faculty of Medicine, University of Rijeka, Rijeka, HRV."
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Petra Pelcic"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Lucija Ruzman"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4rfptgpf48cp0.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.117083",
  "fulltext_url": "https://europepmc.org/articles/PMC13715680",
  "id": "4rfptgpf48cp0",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42953786",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Hematology"
    ],
    [
      "heading",
      "Infectious Disease"
    ],
    [
      "heading",
      "Pediatrics"
    ],
    [
      "openalex",
      "2713|Pneumocystis jirovecii pneumonia detection and treatment"
    ]
  ],
  "openalex": "W7214611972",
  "pdf_url": "https://europepmc.org/articles/PMC13715680?pdf=render",
  "pmcid": "PMC13715680",
  "pmid": "42953786",
  "published": "2026-09-28",
  "publisher": "Cureus Inc.",
  "ris": "https://research.draconitic.com/paper/4rfptgpf48cp0.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:41Z",
      "native_id": "MED:42953786",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42953786"
    },
    {
      "first_seen": "2026-11-01T12:22:54Z",
      "native_id": "PMC13715680",
      "source": "pmc",
      "url": "https://doi.org/10.7759/cureus.117083"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "heading:Infectious Disease",
      "subfield": "infectious-disease"
    },
    {
      "field": "medicine",
      "origin": "heading:Pediatrics",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Pneumocystis jirovecii Pneumonia in an Adolescent With Acute Lymphoblastic Leukemia Due to Non-adherence to Prophylaxis: A Case Report.",
  "title_text": "Pneumocystis jirovecii Pneumonia in an Adolescent With Acute Lymphoblastic Leukemia Due to Non-adherence to Prophylaxis: A Case Report.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:22:54Z",
  "url": "https://research.draconitic.com/paper/4rfptgpf48cp0",
  "venue": "Cureus",
  "versions": []
}