Fatal pneumonia in an AIDS patient coinfected with adenovirus and Pneumocystis carinii

Background: Adenovirus infections are common in immunocompromised hosts. Ho wever, pulmonary adenovirus infections rarely ca use significant morbidity in HIV-infected patients. Patient: Here we describe a 27-year-old man with AIDS who presented with ta chypnea, hypoxemia and an infiltrate in the upper left robe on chest X-ray Bronchoscopy was performed and Pneumocystis carinii was detected in brochoa lveolar ravage (BAL) fluid. Treatment with cotrimoxazole and prednisone ini tially resulted in improvement, but after 10 days the patient's clinical co ndition deteriorated rapidly and he died after 23 days due to respiratory f ailure. Results: On autopsy histopathologic examination showed abundant "smudge cel ls," suggestive of adenoviral infection. Electron microscopy revealed adeno virus-like particles arrayed in a paracrystalline manner. Subsequent immuno histochemistry confirmed the extensive presence of adenovirus in addition t o P. carinii. Conclusion: This case demonstrates a pathogenetic role for adenovirus coinf ection in P.carinii pneumonia (PCP). Earlier diagnosis, e.g. by PCR analysi s of the BAL fluid or transbronchial biopsy, might have led to the consider ation of ribavirin treatment.