{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T23:53:38Z","timestamp":1777679618704,"version":"3.51.4"},"reference-count":18,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Primary prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in people with HIV (PWH) and CD4+ counts &lt;200 cells\/\u00b5L using trimethoprim\/sulfamethoxazole (TMP-SMX) is highly effective but often poorly tolerated. Alternative agents may have limited efficacy or availability. Although rezafungin demonstrated PCP protection comparable to TMP-SMX in animal models, human data are limited to the ongoing ReSPECT trial, and evidence in PWH is lacking. We report the first use of rezafungin as PCP prophylaxis in a PWH. A 43-year-old man presenting with AIDS (HIV-RNA 8.48 \u00d7 106 copies\/mL; CD4+ 20 cells\/\u00b5L) was admitted with disseminated tuberculosis and multiple bowel perforations requiring urgent surgery. The postoperative course was marked by infectious and surgical complications. Antitubercular therapy and TMP-SMX prophylaxis were initiated postoperatively, followed by antiretroviral therapy (ART). Later, TMP-SMX was discontinued due to hypersensitivity. Because drug\u2013drug interactions precluded atovaquone or dapsone and pentamidine was unavailable, rezafungin was started. No adverse events or fungal breakthrough infections occurred despite abdominal complications. Further data are needed to determine whether rezafungin represents a viable prophylactic option when standard agents are contraindicated or unavailable.<\/jats:p>","DOI":"10.3390\/jof12030189","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T10:31:14Z","timestamp":1772706674000},"page":"189","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rezafungin as Primary Prophylaxis of Pneumocystis jirovecii Pneumonia in a Critically Ill Person Presenting with AIDS with Trimethoprim\/Sulfamethoxazole Allergy: A Case Report"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1162-3513","authenticated-orcid":false,"given":"Martina","family":"Bottanelli","sequence":"first","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Mul\u00e8","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4746-3750","authenticated-orcid":false,"given":"Chiara","family":"Molteni","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Gerbi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9322-0798","authenticated-orcid":false,"given":"Mauro Pietro","family":"Zago","sequence":"additional","affiliation":[{"name":"Emergency Surgery Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Volpi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7237-0818","authenticated-orcid":false,"given":"Sofia","family":"Pettenuzzo","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Pandolfo","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4647-5768","authenticated-orcid":false,"given":"Valentina","family":"Morena","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Gemignani","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michele","family":"Fogliata","sequence":"additional","affiliation":[{"name":"Emergency Surgery Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8057-7488","authenticated-orcid":false,"given":"Federico","family":"Conti","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6610-764X","authenticated-orcid":false,"given":"Alessandra","family":"Consonni","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Bradanini","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5628-5941","authenticated-orcid":false,"given":"Silvia","family":"Pontiggia","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-1048","authenticated-orcid":false,"given":"Stefania","family":"Piconi","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Alessandro Manzoni Hospital\u2014ASST Lecco, 23900 Lecco, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"ofaf289","DOI":"10.1093\/ofid\/ofaf289","article-title":"Pneumocystis Pneumonia\u2014Is it Still a Threat Among People with Human Immunodeficiency Virus (HIV)? A Danish HIV Cohort Study","volume":"12","author":"Schnoor","year":"2025","journal-title":"Open Forum Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e0010122","DOI":"10.1128\/cmr.00101-22","article-title":"Pneumocystis jirovecii pneumonia in people living with HIV: A review","volume":"37","author":"McDonald","year":"2024","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e25726","DOI":"10.1002\/jia2.25726","article-title":"No need for secondary Pneumocystis jirovecii pneumonia prophylaxis in adult people living with HIV from Europe on ART with suppressed viraemia and a CD4 cell count greater than 100 cells\/\u00b5L","volume":"24","author":"Atkinson","year":"2021","journal-title":"J. Int. AIDS Soc."},{"key":"ref_4","unstructured":"European AIDS Clinical Society (2024, August 09). EACS Guidelines Version 12.0. Available online: https:\/\/www.eacsociety.org\/media\/guidelines-12.0.pdf."},{"key":"ref_5","unstructured":"(2025, December 19). Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. National Institutes of Health, HIV Medicine Association, and Infectious Diseases Society of America, Available online: https:\/\/clinicalinfo.hiv.gov\/en\/guidelines\/adult-and-adolescent-opportunistic-infection."},{"key":"ref_6","unstructured":"(2025, December 19). Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Bethesda (MD): NIH, CDC, HIVMA\/IDSA; Updated 2024, Available online: https:\/\/clinicalinfo.hiv.gov."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e70043","DOI":"10.1111\/tid.70043","article-title":"Does Switching From Trimethoprim\/Sulfamethoxazole to Atovaquone Result in Less Hyperkalemia? A Single-Center Retrospective Analysis in Heart Transplant Patients","volume":"27","author":"Novakovic","year":"2025","journal-title":"Transpl. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/S0091-6749(94)70048-6","article-title":"Desensitization to trimethoprim\/sulfamethoxazole in HIV-infected patients","volume":"93","author":"Absar","year":"1994","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_9","first-page":"66","article-title":"Management of Hypersensitivity to Trimethoprim-Sulfamethoxazole with an Ultrarapid Desensitization Protocol in HIV Infection","volume":"32","year":"2021","journal-title":"J. Investig. Allergol. Clin. Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.riam.2024.11.001","article-title":"Antifungal pipeline: New tools for the treatment of mycoses","volume":"41","author":"Wolfgruber","year":"2024","journal-title":"Rev. Iberoam. Micol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e0075024","DOI":"10.1128\/aac.00750-24","article-title":"Safety of rezafungin as a long-term treatment option in two patients with complicated fungal infections: Two cases from Lecco Hospital (Italy)","volume":"68","author":"Ponta","year":"2024","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Zhao, Y., and Perlin, D.S. (2020). Review of the Novel Echinocandin Antifungal Rezafungin: Animal Studies and Clinical Data. J. Fungi, 6.","DOI":"10.3390\/jof6040192"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Cushion, M.T., and Ashbaugh, A. (2021). The long-acting echinocandin, rezafungin, prevents Pneumocystis pneumonia and eliminates Pneumocystis from the lungs in prophylaxis and murine treatment models. J. Fungi, 7.","DOI":"10.3390\/jof7090747"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e01992\u2013e20","DOI":"10.1128\/AAC.01992-20","article-title":"Efficacy of Rezafungin in Prophylactic Mouse Models of Invasive Candidiasis, Aspergillosis, and Pneumocystis Pneumonia","volume":"65","author":"Miesel","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Cushion, M.T., Linke, M.J., Ashbaugh, A., Sesterhenn, T., Collins, M.S., Lynch, K., Brubaker, R., and Walzer, P.D. (2010). Echinocandin treatment of Pneumocystis pneumonia in rodent models depletes cysts leaving trophic burdens that cannot transmit the infection. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0008524"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Xie, J., Gao, A., Zhang, W., Zhao, D., and Liu, W. (2025). Efficacy and safety of echinocandins combined with Trimethoprim-Sulfamethoxazole as first-line treatment for Pneumocystis pneumonia in HIV-infected and non-HIV-infected patients. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-11857-8"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S1473-3099(23)00551-0","article-title":"Efficacy and safety of rezafungin and caspofungin in candidaemia and invasive candidiasis: Pooled data from two prospective randomised controlled trials","volume":"24","author":"Thompson","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1080\/14656566.2025.2568547","article-title":"New and emerging drugs for the treatment of invasive fungal infections","volume":"26","author":"Maves","year":"2025","journal-title":"Expert Opin. Pharmacother."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/12\/3\/189\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T11:11:29Z","timestamp":1772709089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/12\/3\/189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,5]]},"references-count":18,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jof12030189"],"URL":"https:\/\/doi.org\/10.3390\/jof12030189","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,5]]}}}