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Case Report

Pulmonary Co-Infection with Pneumocystis jirovecii and Histoplasma capsulatum. Hickam’s Dictum or Occam’s Razor

by
Diego Fernando Severiche-Bueno
1,*,
Silvia J Galvis-Blanco
1,2 and
Jacqueline Mugnier
1
1
Fundación Neumológica Colombiana, Bogotá, DC, Colombia
2
Universidad de La Sabana, Chía, Colombia
*
Author to whom correspondence should be addressed.
GERMS 2025, 15(2), 189-194; https://doi.org/10.18683/germs.2025.1467
Submission received: 15 March 2025 / Revised: 27 June 2025 / Accepted: 28 June 2025 / Published: 30 June 2025

Abstract

Introduction: Co-infection with Histoplasma capsulatum and Pneumocystis jirovecii is rarely documented in HIV-negative immunocompromised patients and poses significant diagnostic challenges due to overlapping radiological patterns and limited access to advanced mycological testing. Case report: A 58-year-old woman with systemic lupus erythematosus and lupus nephritis, under treatment with corticosteroids and cyclophosphamide, presented with fever and hypoxemia. Chest computed tomography demonstrated bilateral micronodules, ground-glass opacities, and mediastinal lymphadenopathy. HIV testing and initial cultures were negative. Bronchoalveolar lavage revealed P. jirovecii, prompting the initiation of trimethoprim-sulfamethoxazole. Despite targeted therapy, the patient developed progressive respiratory failure, requiring intensive care. Transbronchial biopsy later confirmed coinfection with H. capsulatum. Antifungal therapy with liposomal amphotericin B and itraconazole was initiated; however, the clinical course was marked by progressive deterioration, culminating in death. Conclusions: This case highlights the need for high clinical suspicion of dual opportunistic infections in non-HIV immunocompromised patients. Diagnostic delays, particularly in resource-limited settings without fungal PCR, may adversely affect outcomes. In such complex hosts, early invasive diagnostics and broader access to rapid molecular testing are critical to improving prognosis in this vulnerable population.
Keywords: Histoplasma capsulatum; Pneumocystis jirovecii pneumonia; opportunistic infections; immunocompromised host; systemic lupus erythematosus Histoplasma capsulatum; Pneumocystis jirovecii pneumonia; opportunistic infections; immunocompromised host; systemic lupus erythematosus

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MDPI and ACS Style

Severiche-Bueno, D.F.; Galvis-Blanco, S.J.; Mugnier, J. Pulmonary Co-Infection with Pneumocystis jirovecii and Histoplasma capsulatum. Hickam’s Dictum or Occam’s Razor. GERMS 2025, 15, 189-194. https://doi.org/10.18683/germs.2025.1467

AMA Style

Severiche-Bueno DF, Galvis-Blanco SJ, Mugnier J. Pulmonary Co-Infection with Pneumocystis jirovecii and Histoplasma capsulatum. Hickam’s Dictum or Occam’s Razor. GERMS. 2025; 15(2):189-194. https://doi.org/10.18683/germs.2025.1467

Chicago/Turabian Style

Severiche-Bueno, Diego Fernando, Silvia J Galvis-Blanco, and Jacqueline Mugnier. 2025. "Pulmonary Co-Infection with Pneumocystis jirovecii and Histoplasma capsulatum. Hickam’s Dictum or Occam’s Razor" GERMS 15, no. 2: 189-194. https://doi.org/10.18683/germs.2025.1467

APA Style

Severiche-Bueno, D. F., Galvis-Blanco, S. J., & Mugnier, J. (2025). Pulmonary Co-Infection with Pneumocystis jirovecii and Histoplasma capsulatum. Hickam’s Dictum or Occam’s Razor. GERMS, 15(2), 189-194. https://doi.org/10.18683/germs.2025.1467

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