Generalized <i>Pneumocystis carinii</i> Infection with Severe Idiopathic Hypoproteinemia

Abstract

A case is reported of generalized Pneumocystis carinii infection. The patient, a 54-year-old man, developed pulmonary symptoms after he had felt extremely weak for more than 1 year. Because of radiological suspicion of a pulmonary cyst or abscess a lobectomy was performed. Microscopic examination showed Pneumocystis carinii pneumonia. Five months later the patient died from generalized Pneumocystis carinii infection. At autopsy numerous small abscesses were found in which the pneumocyst could be demonstrated. Hypoproteinemic edema developed 2 months before death. An extreme hypoalbuminemia was demonstrated (serum albumin, 0.2 g/100 ml), and there was a strongly reduced serum concentration of immunoglobulin (Ig)G but normal concentrations of IgA and IgM. Using 125I-albumin, a greatly increased turnover of albumin was demonstrated, as in proteinlosing states. However, there was no abnormal loss of plasma protein, in particular none in the gastrointestinal tract (normal 59Fe-iron-dextran test).