A 25-year-old patient with no morbid history.
Located by an unquantified weight loss of four months of evolution.
One month before admission, the patient developed odynophagia and dysphagia, which confirmed oropharyngeal and esophageal candidiasis by endoscopy.
No specific treatment was given and a possible HIV infection was investigated, which was later confirmed.
Physical examination revealed a marked weakness and lesions compatible with oropharyngeal candidiasis.
The patient was afflicted, eupneic, with pulmonary examination and normal chest X-ray.
Prophylaxis was initiated with 960 mg of cotrimoxazole daily, 15 mg of acid daily, 150 mg of fluconazole daily and antiretroviral therapy (HAART) with abacavir/very good folic acid and efavirenz adherence.
Two weeks later she consulted for three days of fever up to 39°C, headache and dry cough.
The patient was hospitalized for a fever of 39°C, tachycardia and oxygen saturation of 93% with room air.
Physical examination showed no evidence of oral candidiasis and lung examination at that time was normal.
Chest X-ray showed diffuse bilateral cotton-wool infiltrate.
The expectoration, uroculture, hemocultive and bacilloscopy cultures were negative.
CPR for cystis jiroveci in a sample of induced expectoration was negative.
Prophylactic dose cotrimoxazole was adjusted to intravenous therapy, prednisone and ceftriaxone IV were added, folinic acid was discontinued, and recently the starting drug was maintained.
At 48 h, the patient developed adequate oxygen saturation, with improvement in inflammatory parameters.
She was discharged on the fifth day with oral cotrimoxazole and prednisone for 21 days.
In the outpatient follow-up, the patient was completely asymptomatic and the X-ray showed the disappearance of the pulmonary infiltrate.
