Pneumocystis jirovecii Pneumonia in an Adolescent With Acute Lymphoblastic Leukemia Due to Non-adherence to Prophylaxis: A Case Report.
- 1Department of Pediatrics, Division of Hematology and Oncology, Clinical Hospital Center Rijeka, Rijeka, HRV.
- 2Department of Pediatrics, Faculty of Medicine, University of Rijeka, Rijeka, HRV.
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.
Related
- Pneumocystis Jirovecii Pneumonia Associated with Prolonged CD4-positive T-cell Depletion after Bendamustine-Rituximab Therapy: A Case Report
- Added Value of Next-Generation Sequencing for Multilocus Sequence Typing Analysis of a Pneumocystis jirovecii Pneumonia Outbreak1
- Very Late-Onset Cytomegalovirus Disease With Pneumocystis jirovecii Pneumonia Coinfection in a Renal Transplant Recipient: A Case Report and Narrative Review of Published Cases.
- Association of PCR cycle threshold values in respiratory specimens with mechanical ventilation and mortality in HIV-negative pneumocystis jirovecii pneumonia
- Factors associated with severe disease and in-hospital mortality in children with non-HIV-associated Pneumocystis jirovecii pneumonia: a single-center retrospective cohort study
BibTeX
@article{pelcic2026pneumocystis,
title = {{Pneumocystis jirovecii Pneumonia in an Adolescent With Acute Lymphoblastic Leukemia Due to Non-adherence to Prophylaxis: A Case Report.}},
author = {Petra Pelcic and Lucija Ruzman},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117083},
url = {https://europepmc.org/article/MED/42953786},
note = {CC BY},
}
RIS
TY - JOUR
TI - Pneumocystis jirovecii Pneumonia in an Adolescent With Acute Lymphoblastic Leukemia Due to Non-adherence to Prophylaxis: A Case Report.
AU - Petra Pelcic
AU - Lucija Ruzman
PY - 2026
DA - 2026/09/28
JO - Cureus
DO - 10.7759/cureus.117083
UR - https://europepmc.org/article/MED/42953786
AB - 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.
SN - 2168-8184
ER -