{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:39Z","timestamp":1787017059052,"version":"build-2736575974"},"reference-count":9,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,3,27]]},"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:p>\n                    We describe a case of opportunistic coinfections with\n                    <jats:italic>Coccidioides immitis<\/jats:italic>\n                    and\n                    <jats:italic>Pneumocystis jirovecii<\/jats:italic>\n                    following treatment with idelalisib, a phosphoinositide 3-kinase inhibitor, for chronic lymphocytic leukaemia. This is the first case of pulmonary coccidioidomycosis reported in association with idelalisib. We review challenges related to diagnosis of opportunistic infections in this context. This report illustrates (1) the uncommon occurrence of two opportunistic infections concurrently or in rapid succession, (2) the importance of maintaining a broad differential diagnosis in the setting of an atypical imaging finding, slow clinical response or when immunomodulatory drugs are used, and (3) the challenges associated with non-invasive serological testing in individuals with haematological malignancy on immunomodulatory therapy.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2019-234113","type":"journal-article","created":{"date-parts":[[2020,4,30]],"date-time":"2020-04-30T04:15:45Z","timestamp":1588220145000},"page":"e234113","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Opportunistic coinfection with\n                    <i>Pneumocystis jirovecii<\/i>\n                    and\n                    <i>Coccidioides immitis<\/i>\n                    associated with idelalisib treatment in a patient with chronic lymphocytic leukaemia"],"prefix":"10.1136","volume":"13","author":[{"given":"Lindsey M","family":"Ward","sequence":"first","affiliation":[{"name":"University of California San Francisco School of Medicine, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5358-3535","authenticated-orcid":false,"given":"Michael J","family":"Peluso","sequence":"additional","affiliation":[{"name":"Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA"},{"name":"Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jehan Z","family":"Budak","sequence":"additional","affiliation":[{"name":"Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett M","family":"Elicker","sequence":"additional","affiliation":[{"name":"Division of Radiology, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter V","family":"Chin-Hong","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Lampiris","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA"},{"name":"Infectious Disease Section, Medical Service, San Francisco Veterans\u2019 Affairs Medical Center, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer S","family":"Mulliken","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of California San Francisco, San Francisco, California, USA"},{"name":"Infectious Disease Section, Medical Service, San Francisco Veterans\u2019 Affairs Medical Center, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,4,29]]},"reference":[{"key":"2025082709580666000_13.4.e234113.1","doi-asserted-by":"publisher","DOI":"10.1078\/1434-4610-00107"},{"key":"2025082709580666000_13.4.e234113.2","doi-asserted-by":"crossref","DOI":"10.1182\/blood.V128.22.3705.3705","article-title":"A retrospective analysis of Pneumocystis jirovecii pneumonia infection in patients receiving idelalisib in clinical trials","volume":"128","author":"Sehn","year":"2016","journal-title":"Blood"},{"key":"2025082709580666000_13.4.e234113.3","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2017.164103"},{"key":"2025082709580666000_13.4.e234113.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1315226"},{"key":"2025082709580666000_13.4.e234113.5","doi-asserted-by":"publisher","DOI":"10.1086\/496991"},{"key":"2025082709580666000_13.4.e234113.6","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.1.113"},{"key":"2025082709580666000_13.4.e234113.7","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir435"},{"key":"2025082709580666000_13.4.e234113.8","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jocn.2014.06.013","article-title":"Coccidioides parenchymal cerebral abscess in the setting of lymphoma","volume":"22","author":"Motley","year":"2015","journal-title":"J Clin Neurosci"},{"key":"2025082709580666000_13.4.e234113.9","first-page":"610","article-title":"Multiple pneumonias in a man infected with HIV","volume":"37","author":"Carmichael","year":"1993","journal-title":"J Fam Pract"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-234113","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:58:15Z","timestamp":1756313895000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-234113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4]]},"references-count":9,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,4,29]]},"published-print":{"date-parts":[[2020,4]]}},"alternative-id":["10.1136\/bcr-2019-234113"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-234113","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4]]}}}