Fatal Pneumocystis jirovecii Pneumonia in a Severely Malnourished Infant with Undiagnosed HIV: A Case Report

Abstract

This report describes a 5-month-old infant who presented with failure to thrive, severe respiratory distress and oral candidiasis. The clinical course was complicated by severe acute malnutrition, electrolyte imbalances characteristic of refeeding syndrome and progressive respiratory failure. A reactive serologic test for Human Immunodeficiency Virus (HIV) obtained during blood transfusion cross-matching prompted further investigation, with posthumous confirmatory results establishing HIV-1 infection, underscoring a delay in diagnosis. The pneumonia was attributed to Pneumocystis jirovecii (PCP). Although the infant met clinical criteria for severe PCP, adjunctive corticosteroids, which are recommended in such cases, were not initiated, representing a missed therapeutic opportunity. The illness evolved into a hyperinflammatory state resembling Hemophagocytic Lymphohistiocytosis (HLH), with multiorgan dysfunction, Acute Respiratory Distress Syndrome (ARDS) and pulmonary hemorrhage. Despite broad-spectrum antimicrobials and intensive supportive care, the outcome was fatal. This case highlights the importance of early HIV screening, timely initiation of PCP prophylaxis with adjunctive corticosteroids, and careful management of refeeding syndrome in severely malnourished infants.

Cite this article as: Ong BY. Fatal Pneumocystis jirovecii pneumonia in a severely malnourished HIV-positive infant. Pediatr Acad Case Rep. 2026;5(3):73-8.