Pneumocystis jirovecii Pneumonia in a Kidney Transplant Recipient: A Case Report and Regional Literature Review

Background

Pneumocystis jirovecii pneumonia (PJP) is a significant opportunistic infection in kidney transplant recipients, with a prevalence of ~1.28% in late-onset settings and mortality 10–50%. Despite TMP-SMX prophylaxis, PJP occurs with intensified immunosuppression, acute rejection, or CMV co-infection. Its nonspecific presentation delays diagnosis and worsens outcomes. Late-onset PJP is recognized. Case Presentation: A 29-year-old male kidney transplant recipient developed PJP eleven months post-transplantation from his HLA semi-identical mother. He presented with fever (39°C), exertional dyspnea, and oxygen saturation 85% on ambient air. Chest radiography showed bilateral alveolar-interstitial infiltrates; CT revealed diffuse ground-glass opacities with septal reticulations ("crazy-paving"). He received oxygen therapy, sulfamethoxazole (10 mg/kg for 28 days), and cefotaxime (15 days), with progressive improvement and stable graft function.