Pneumocystis jirovecii in a patient on dose-dense chemotherapy for early breast cancer

Chloe Khoo, Jenny Gilchrist, Jonathan Philip Williamson, Miriam Paul, Richard Kefford

Research output: Contribution to journalArticleResearchpeer-review

Abstract

A 70-year-old woman underwent adjuvant chemotherapy with dose-dense doxorubicin and cyclophosphamide for early breast cancer. After her fourth cycle of chemotherapy, she developed severe fatigue and cough with rapid-onset hypoxic respiratory failure. Investigations demonstrated extensive bilateral consolidation with positive bronchial washings for Pneumocystis jirovecii by polymerase chain reaction (PCR). Despite high-dose trimethoprim-sulfamethoxazole, she progressed to multi-organ failure and succumbed. Pneumocystis jirovecii pneumonia (PJP) has traditionally rarely occurred in women on adjuvant breast cancer chemotherapy but may pose a more serious risk in dose-dense regimes due to higher concurrent exposure to anti-emetic corticosteroids. Clinicians are alerted to the need for vigilance of this rare complication and for rationalization of dexamethasone dosage to mitigate this risk, particularly in the era of modern triple-agent anti-emetic regimens.

LanguageEnglish
Article numbere00459
Pages1-4
Number of pages4
JournalRespirology Case Reports
Volume7
Issue number7
DOIs
Publication statusPublished - Oct 2019

Fingerprint

Pneumocystis carinii
Antiemetics
Breast Neoplasms
Drug Therapy
Pneumocystis Pneumonia
Sulfamethoxazole Drug Combination Trimethoprim
Adjuvant Chemotherapy
Cough
Respiratory Insufficiency
Doxorubicin
Cyclophosphamide
Dexamethasone
Fatigue
Adrenal Cortex Hormones
Polymerase Chain Reaction

Bibliographical note

Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • Adjuvant chemotherapy
  • breast cancer
  • corticosteroids
  • dose-dense chemotherapy
  • Pneumocystis jirovecii

Cite this

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title = "Pneumocystis jirovecii in a patient on dose-dense chemotherapy for early breast cancer",
abstract = "A 70-year-old woman underwent adjuvant chemotherapy with dose-dense doxorubicin and cyclophosphamide for early breast cancer. After her fourth cycle of chemotherapy, she developed severe fatigue and cough with rapid-onset hypoxic respiratory failure. Investigations demonstrated extensive bilateral consolidation with positive bronchial washings for Pneumocystis jirovecii by polymerase chain reaction (PCR). Despite high-dose trimethoprim-sulfamethoxazole, she progressed to multi-organ failure and succumbed. Pneumocystis jirovecii pneumonia (PJP) has traditionally rarely occurred in women on adjuvant breast cancer chemotherapy but may pose a more serious risk in dose-dense regimes due to higher concurrent exposure to anti-emetic corticosteroids. Clinicians are alerted to the need for vigilance of this rare complication and for rationalization of dexamethasone dosage to mitigate this risk, particularly in the era of modern triple-agent anti-emetic regimens.",
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author = "Chloe Khoo and Jenny Gilchrist and Williamson, {Jonathan Philip} and Miriam Paul and Richard Kefford",
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Pneumocystis jirovecii in a patient on dose-dense chemotherapy for early breast cancer. / Khoo, Chloe; Gilchrist, Jenny; Williamson, Jonathan Philip; Paul, Miriam; Kefford, Richard.

In: Respirology Case Reports, Vol. 7, No. 7, e00459, 10.2019, p. 1-4.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Khoo, Chloe

AU - Gilchrist, Jenny

AU - Williamson, Jonathan Philip

AU - Paul, Miriam

AU - Kefford, Richard

N1 - Copyright the Author(s) 2019. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2019/10

Y1 - 2019/10

N2 - A 70-year-old woman underwent adjuvant chemotherapy with dose-dense doxorubicin and cyclophosphamide for early breast cancer. After her fourth cycle of chemotherapy, she developed severe fatigue and cough with rapid-onset hypoxic respiratory failure. Investigations demonstrated extensive bilateral consolidation with positive bronchial washings for Pneumocystis jirovecii by polymerase chain reaction (PCR). Despite high-dose trimethoprim-sulfamethoxazole, she progressed to multi-organ failure and succumbed. Pneumocystis jirovecii pneumonia (PJP) has traditionally rarely occurred in women on adjuvant breast cancer chemotherapy but may pose a more serious risk in dose-dense regimes due to higher concurrent exposure to anti-emetic corticosteroids. Clinicians are alerted to the need for vigilance of this rare complication and for rationalization of dexamethasone dosage to mitigate this risk, particularly in the era of modern triple-agent anti-emetic regimens.

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