Pulmonary co‐infections by Pneumocystis jirovecii and Aspergillus fumigatus in non‐HIV patients: A report of two cases and literature review

Pneumocystis jirovecii is the causative agent of Pneumocystis pneumonia (PcP), a common and often life‐threatening opportunistic infection in HIV‐infected patients. However, non‐HIV, immunocompromised patients are at risk of PcP as well, whereas the mortality appears to be higher among these patients. Pneumocystis co‐infections with other microorganisms are less frequent and only sparse reports of combined PcP and invasive pulmonary fungal infections exist in the literature, especially in the non‐HIV patients. Two cases of pulmonary co‐infections by P. jirovecii and Aspergillus fumigatus are presented. Both patients were non‐HIV infected, the first one was suffering from crescentic IgA nephropathy under immunosuppressive treatment and the second from resistant non‐Hodgkin lymphoma under chemotherapy. Both patients were treated with intravenous trimethoprim/sulphamethoxazole (TMP/SMX) combined with voriconazole. The first patient showed gradual clinical improvement while the outcome for the second patient was unfavourable. In addition, a literature review of the previous published cases of co‐infection by P. jirovecii and other fungi in non‐HIV patients was performed. Our target was to provide comprehensive information on this kind of infections, highlighting the importance of clinical suspicion.