Case 1: Prophylaxis for Pneumocystis Pneumonia

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Case last updated: June 30, 2004

A 38-year-old man presents for care after being recently diagnosed with HIV infection. He has been diagnosed with community-acquired pneumonia 3 times in the last year. He takes no medications and thinks he may be allergic to "sulfa" since he developed some pruritis and a mild rash while taking trimethoprim-sulfamethoxazole (Bactrim, Septra) for one of his episodes of pneumonia. He currently has no respiratory symptoms and his physical examination is notable for seborrheic dermatitis, poor dentition, and obvious oral candidiasis. He is seropositive for Toxoplasma gondii.

Which of the following is true regarding prophylaxis for Pneumocystis pneumonia?

	This patient may be a candidate for Pneumocystis pneumonia prophylaxis, but he should be considered for prophylaxis only if his CD4 cell count is less than 200 cells/mm3.
	The patient should be started on prophylaxis for Pneumocystis pneumonia, but given his history of pruritis and rash, trimethoprim-sulfamethoxazole would not be an option.
	The patient should be started on Pneumocystis pneumonia prophylaxis using trimethoprim-sulfamethoxazole. You should consider introducing trimethoprim-sulfamethoxazole desensitization given his possible allergy to "sulfa".
	The patient has AIDS and active oral candidiasis. He should be admitted to the hospital and bronchoscopy performed to rule out active Pneumocystis pneumonia prior to receiving prophylaxis.
	Prior to initiating prophylaxis, a sputum sample should be sent to perform Pneumocystis jiroveci (formerly Pneumocystis carinii) resistance testing.