Pneumocystis jirovecii pneumonia in patients with decompensated cirrhosis: A Case Series.

OBJECTIVES: Pneumocystis jirovecii pneumonia (PCP) incidence is increasing in people without HIV. Decompensated liver cirrhosis is not currently considered as a risk factor for PCP. The aim of this paper is to describe a case series of patients with decompensated liver cirrhosis and PCP.

METHODS: All consecutive patients hospitalized with decompensated cirrhosis and microbiology-confirmed PCP at Policlinico Modena University Hospital from January 1st 2016 to December 31st 2021 were included in our series.

RESULTS: Eight patients were included. All patients had advanced stage liver disease with a MELD-score above 15 (6/8 above 20). Four were in active orthotopic liver transplant waiting list at the time of PCP diagnosis. Five patients did not have any traditional risk factor for PCP, while the other three were on glucocorticoid treatment for acute on chronic liver. All patients were treated with cotrimoxazole, except two who died before the diagnosis. Five patients died (62.5%), four of them within 30 days from PCP diagnosis. Of the remaining 3, one patient underwent liver transplantation.

CONCLUSIONS: Whereas further studies are needed, in patients with decompensated cirrhosis, mainly due to severe alcoholic hepatitis and on corticosteroids therapy, liver cirrhosis can be an independent risk factor for PCP and primary prophylaxis for PCP should be considered.