A 29-year-old HIV-positive man (CD4 count 130 cells/uL, not on ART) has 2 weeks of progressive exertional dyspnoea and dry cough. Chest radiograph shows bilateral interstitial infiltrates, LDH is 620 U/L. On room air, ABG shows PaO2 56 mmHg. He is started on intravenous trimethoprim-sulfamethoxazole. What is the most appropriate addition to his regimen?

• A Oral prednisone ✓
• B Inhaled pentamidine
• C Clindamycin plus primaquine
• D Casposfungin

Explanation

Adjunctive corticosteroids are indicated in Pneumocystis jirovecii pneumonia when PaO2 is below 70 mmHg or the alveolar-arterial gradient exceeds 35 mmHg. Steroids given early reduce the risk of respiratory deterioration that occurs as organisms die and inflammation flares during the first days of treatment. Clindamycin-primaquine is an alternative regimen for intolerance, not an addition, and inhaled pentamidine is second line and used for prophylaxis.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.