{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T03:12:55Z","timestamp":1768273975763,"version":"3.49.0"},"reference-count":44,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T00:00:00Z","timestamp":1616544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: Establishing the diagnosis of COVID-19 and Pneumocystisjirovecii pulmonary coinfection is difficult due to clinical and radiological similarities that exist between the two disorders. For the moment, fungal coinfections are underestimated in COVID-19 patients. Case presentation: We report the case of a 52-year-old male patient, who presented to the emergency department for severe dyspnea and died 17 h later. The RT-PCR test performed at his admission was negative for SARS-CoV-2. Retesting of lung fragments collected during autopsy revealed a positive result for SARS-CoV-2. Histopathological examination showed preexisting lesions, due to comorbidities, as well as recent lesions: massive lung thromboses, alveolar exudate rich in foam cells, suprapleural and intra-alveolar Pneumocystisjirovecii cystic forms, and bilateral adrenal hemorrhage. Conclusion: COVID-19 and P.jirovecii coinfection should be considered, particularly in critically ill patients, and we recommend the systematic search for P. jirovecii in respiratory samples.<\/jats:p>","DOI":"10.3390\/medicina57040302","type":"journal-article","created":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T15:42:19Z","timestamp":1616600539000},"page":"302","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["COVID-19 and Pneumocystis jirovecii Pulmonary Coinfection\u2014The First Case Confirmed through Autopsy"],"prefix":"10.3390","volume":"57","author":[{"given":"Ionu\u021b Isaia","family":"Jeican","sequence":"first","affiliation":[{"name":"Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"},{"name":"Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Ini\u0219ca","sequence":"additional","affiliation":[{"name":"Department of Pathology, County Emergency Hospital Deva, 330084 Deva, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Gheban","sequence":"additional","affiliation":[{"name":"Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5744-0451","authenticated-orcid":false,"given":"Flaviu","family":"T\u0103b\u0103ran","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Alua\u0219","sequence":"additional","affiliation":[{"name":"Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Trombitas","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Cristea","sequence":"additional","affiliation":[{"name":"Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Crivii","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Embryology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3550-7966","authenticated-orcid":false,"given":"Lia Monica","family":"Junie","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2858-8470","authenticated-orcid":false,"given":"Silviu","family":"Albu","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery and Otorhinolaryngology, University Clinical Hospital of Railway Company, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"19867","DOI":"10.18632\/aging.103941","article-title":"CD45: A critical regulator in immune cells to predict severe and non-severe COVID-19 patients","volume":"12","author":"Jin","year":"2020","journal-title":"Aging"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/s41577-020-0308-3","article-title":"COVID-19: Immunopathology and its implications for therapy","volume":"20","author":"Cao","year":"2020","journal-title":"Nat. Rev. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1001\/jama.2020.12839","article-title":"Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review","volume":"324","author":"Wiersinga","year":"2020","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.ijid.2020.07.061","article-title":"Concurrent COVID-19 and Pneumocystis jirovecii pneumonia in a severely immunocompromised 25-year-old patient","volume":"99","author":"Bhat","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Messina, F.A., Marin, E., Caceres, D.H., Romero, M., Depardo, R., Priarone, M.M., Rey, L., V\u00e1zquez, M., Verweij, P.E., and Chiller, T.M. (2020). Coronavirus Disease 2019 (COVID-19) in a Patient with Disseminated Histoplasmosis and HIV\u2014A Case Report from Argentina and Literature Review. J. Fungi, 6.","DOI":"10.3390\/jof6040275"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e00009-18","DOI":"10.1128\/CMR.00009-18","article-title":"A Molecular Window into the Biology and Epidemiology of Pneumocystis spp.","volume":"31","author":"Ma","year":"2018","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1051\/parasite\/2011183219","article-title":"Pneumocystis jirovecii pneumonia in developing countries","volume":"18","author":"Wissmann","year":"2011","journal-title":"Parasite"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1086\/319340","article-title":"Search for primary infection by Pneumocystis carinii in a cohort of normal, healthy infants","volume":"32","author":"Vargas","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1164\/rccm.202003-0766LE","article-title":"A Case of COVID-19 and Pneumocystis jirovecii Coinfection","volume":"202","author":"Menon","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1097\/QAD.0000000000002571","article-title":"Coronavirus disease 2019 and Pneumocystis jirovecii pneumonia: A diagnostic dilemma in HIV","volume":"34","author":"Coleman","year":"2020","journal-title":"AIDS"},{"key":"ref_11","unstructured":"Alanio, A., Delli\u00e8re, S., Voicu, S., Bretagne, S., and M\u00e9garbane, B. (2020). The presence of Pneumocystis jirovecii in critically ill patients with COVID-19. J. Infect., S0163-4453(20)30694-0."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e25533","DOI":"10.1002\/jia2.25533","article-title":"It\u2019s not all about COVID-19: Pneumocystis pneumonia in the era of a respiratory outbreak","volume":"23","author":"Choy","year":"2020","journal-title":"J. Int. AIDS Soc."},{"key":"ref_13","unstructured":"Baron, S. (2020, December 01). Pneumocystis Carinii, Medical Microbiology, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK8137\/."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.2214\/AJR.20.22976","article-title":"Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study","volume":"214","author":"Zhao","year":"2020","journal-title":"Am. J. Roentgenol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2000045","DOI":"10.2807\/1560-7917.ES.2020.25.3.2000045","article-title":"Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR","volume":"25","author":"Corman","year":"2020","journal-title":"Euro. Surveill."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/S2213-2600(18)30274-1","article-title":"Dutch-Belgian Mycosis study group. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: A retrospective cohort study","volume":"6","author":"Schauwvlieghe","year":"2018","journal-title":"Lancet. Respir. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.riam.2020.07.001","article-title":"Fungal co-infection in COVID-19 patients: Should we be concerned?","volume":"37","author":"Salavert","year":"2020","journal-title":"Rev. Iberoam. Micol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"White, P.L., Dhillon, R., Cordey, A., Hughes, H., Faggani, F., Soni, S., Pandey, M., Whitaker, H., May, A., and Morgan, M. (2020). A national strategy to diagnose COVID-19 associated invasive fungal disease in the ICU. Clin. Infect. Dis., ciaa1298.","DOI":"10.2139\/ssrn.3644400"},{"key":"ref_20","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_21","doi-asserted-by":"crossref","unstructured":"Otieno-Odhiambo, P., Wasserman, S., and Hoving, J.C. (2019). The Contribution of Host Cells to Pneumocystis Immunity: An Update. Pathogens, 8.","DOI":"10.3390\/pathogens8020052"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2487","DOI":"10.1056\/NEJMra032588","article-title":"Pneumocystis pneumonia","volume":"350","author":"Thomas","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2865","DOI":"10.1242\/jcs.01166","article-title":"iNOS (NOS2) at a glance","volume":"117","author":"Lowenstein","year":"2004","journal-title":"J. Cell Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1007\/s00414-020-02319-8","article-title":"Gross and histopathological pulmonary findings in a COVID-19 associated death during self-isolation","volume":"134","author":"Suess","year":"2020","journal-title":"Int. J. Legal Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e438","DOI":"10.1016\/S2352-3026(20)30145-9","article-title":"Coagulation abnormalities and thrombosis in patients with COVID-19","volume":"7","author":"Levi","year":"2020","journal-title":"Lancet Haematol."},{"key":"ref_26","first-page":"e9866","article-title":"Hamman-Rich Syndrome: A Diagnosis of Exclusion in the COVID-19 Pandemic","volume":"12","author":"Zhang","year":"2020","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.4269\/ajtmh.20-0722","article-title":"Case Report: COVID-19 with Bilateral Adrenal Hemorrhage","volume":"103","author":"Larrauri","year":"2020","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"dgaa487","DOI":"10.1210\/clinem\/dgaa487","article-title":"Bilateral Adrenal Hemorrhage in Coronavirus Disease 2019 Patient: A Case Report","volume":"105","author":"Frankel","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"202504","DOI":"10.1148\/radiol.2020202504","article-title":"Review of the Chest CT Differential Diagnosis of Ground-Glass Opacities in the COVID Era","volume":"297","author":"Parekh","year":"2020","journal-title":"Radiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S1473-3099(20)30086-4","article-title":"Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive study","volume":"20","author":"Shi","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2578","DOI":"10.1001\/jama.2009.880","article-title":"Evolving health effects of Pneumocystis: One hundred years of progress in diagnosis and treatment","volume":"301","author":"Kovacs","year":"2009","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"W555","DOI":"10.2214\/AJR.11.7329","article-title":"Pneumocystis jiroveci pneumonia: High-resolution CT findings in patients with and without HIV infection","volume":"198","author":"Kanne","year":"2012","journal-title":"Am. J. Roentgenol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1038\/s41598-021-81782-8","article-title":"Overcoming limitations in the availability of swabs systems used for SARS-CoV-2 laboratory diagnostics","volume":"11","author":"Nairz","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_34","unstructured":"Truong, J., and Ashurst, J.V. (2020, December 01). Pneumocystis Jiroveci Pneumonia, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482370\/."},{"key":"ref_35","unstructured":"Kon, K., and Rai, M. (2016). Laboratory diagnosis of Pneumocystis jirovecii pneumonia. Microbiology of Respiratory System Infection, Elsevier."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"6283935","DOI":"10.1155\/2018\/6283935","article-title":"Positive Pneumocystis jirovecii Sputum PCR Results with Negative Bronchoscopic PCR Results in Suspected Pneumocystis Pneumonia","volume":"2018","author":"Pennington","year":"2018","journal-title":"Can. Respir. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"245","DOI":"10.3201\/eid1102.040487","article-title":"Pneumocystis jirovecii in general population","volume":"11","author":"Medrano","year":"2005","journal-title":"Emerg. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Mercier, T., Aissaoui, N., Gits-Muselli, M., Hamane, S., Prattes, J., Kessler, H.H., Marekovi\u0107, I., Ple\u0161ko, S., Steinmann, J., and Scharmann, U. (2020). Variable correlation between bronchoalveolar lavage fluid fungal load and serum-(1,3)-\u03b2-d-Glucan in patients with Pneumocystosis\u2014A multicenter ECMM excellence center study. J. Fungi, 6.","DOI":"10.3390\/jof6040327"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Djawe, K., Huang, L., Daly, K.R., Levin, L., Koch, J., Schwartzman, A., Fong, S., Roth, B., Subramanian, A., and Grieco, K. (2010). Serum antibody levels to the Pneumocystis jirovecii major surface glycoprotein in the diagnosis of P. jirovecii pneumonia in HIV+ patients. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0014259"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1080\/14787210.2017.1305887","article-title":"Diagnosis and management of Pneumocystis jirovecii infection","volume":"15","author":"White","year":"2017","journal-title":"Expert Rev. Anti. Infect. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Matos, O., Tom\u00e1s, A.L., and Antunes, F. (2017). Pneumocystis jirovecii and PcP. Current Progress in Medical Mycology, Springer.","DOI":"10.1007\/978-3-319-64113-3_7"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1001\/jama.286.19.2450","article-title":"New insights into transmission, diagnosis, and drug treatment of Pneumocystis carinii pneumonia","volume":"286","author":"Kovacs","year":"2001","journal-title":"J. Am. Med. Assoc."},{"key":"ref_43","unstructured":"Centers for Disease Control and Prevention (1989). Guidelines for prophylaxis against Pneumocystis carinii pneumonia for persons infected with human immunodeficiency virus. MMWR Morb Mortal Wkly Rep., 38, 1\u20139."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"ofaa633","DOI":"10.1093\/ofid\/ofaa633","article-title":"Pneumocystis and severe acute respiratory syndrome coronavirus 2 coinfection: A case report and review of an emerging diagnostic dilemma","volume":"8","author":"Rubiano","year":"2020","journal-title":"Open Forum Infect. Dis."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/4\/302\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:40:15Z","timestamp":1760161215000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/4\/302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,24]]},"references-count":44,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["medicina57040302"],"URL":"https:\/\/doi.org\/10.3390\/medicina57040302","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,24]]}}}