Fatal Case of Suspected Pneumocystis jirovecii Pneumonia in a Patient with HIV Stage III and Discontinued ART: A Case Report from Rural Indonesia

Abstract

Pneumocystis jirovecii pneumonia (PJP) remains a significant opportunistic infection in HIV patients with poor antiretroviral adherence, especially in low-resource settings. We report a 36-year-old Indonesian male with HIV stage III, who presented to the emergency department with loss of consciousness following a progressive history of weakness, weight loss, dry cough, and dyspnea. The patient had defaulted antiretroviral therapy (ART) for one year. On admission, the patient exhibited candidiasis, bilateral rhonchi, anemia, and electrolyte imbalance. Chest X-ray showed bilateral infiltrates. Cotrimoxazole, ceftriaxone, and supportive care were initiated. On day 4, methylprednisolone was added due to worsening dyspnea. Despite treatment, the patient deteriorated and died on day 7. This case highlights the importance of ART adherence and early diagnosis of PJP. Lack of access to advanced diagnostics and limited response to oral therapy in the presence of systemic immunosuppression contributed to the fatal outcome.