Dr. Refugio presented a classic case of Pneumocystis jirovecci pneumonia (PJP) in a patient with newly diagnosed HIV.

Here are some important learning points:

• The classic presenting symptoms for PJP are fever, non-productive cough, and progressive dyspnea
• Most cases occur with a CD4 count <200
• CXR can be normal in up to 1/4th of patients, but most commonly show bilateral interstitial or alveolar infiltrates
• Elevated LDH and 1-3-beta-D-glucan are usually seen, but definitive diagnosis requires visualizing the organism on respiratory sample

High Yield: In acutely ill patients, empiric treatment with TMP-SMX should be initiated if there is a high clinical suspicion for PJP without waiting for a definitive diagnosis. Patients with an elevated A-a gradient >35mmHg and/or PaO2 <70mmHg should also be treated concurrently with steroids. 

Check out this awesome Dyspnea Pyramid advanced organizer from The CurbSiders for some more learning!