Korean J Crit Care Med.  2016 May;31(2):162-168. 10.4266/kjccm.2016.31.2.162.

Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumocystis jirovecii Pneumonia: Case Report and Literature Review

  • 1Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea. paihj@hanyang.ac.kr


Pnuemocystis jirovecii pneumonia (PJP) is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV), and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO) treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART) initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.


extracorporeal membrane oxygenation; HIV; Pneumocystis jirovecii; respiratory failure

MeSH Terms

Antiretroviral Therapy, Highly Active*
Extracorporeal Membrane Oxygenation*
Pneumocystis jirovecii*
Respiration, Artificial
Respiratory Distress Syndrome, Adult*
Respiratory Insufficiency
Salvage Therapy


  • Fig. 1. Chest radiograph and computed tomography. Chest radiography and computed tomography images were obtained on hospital days 1 (A, B), 6 (C), and 19 (D, E). A and B. Chest radiographs show increased patchy opacities, and chest computed tomography reveals diffuse ground-glass opacities with a mosaic pattern in both lungs on admission. C. Chest radiography reveals mild improvement of the ground-glass density in both lungs after TMP/SMX therapy with corticosteroids on hospital day 6. D and E. Aggravated diffuse consolidation and ground-glass opacities were noted on chest radiograph and computed tomography on hospital day 19 at the time of ECMO initiation. ECMO: extracorporeal membrane oxygenation; TMP/SMX: trimethoprim/sulfamethoxazole.

  • Fig. 2. Sequence of major clinical and laboratory events. HD: hospital days; TMP/SMX: trimethoprim/sulfamethoxazole; IV: intravenous; HAART: highly active antiretroviral therapy; MV: mechanical ventilation; ECMO: extracorporeal membrane oxygenation; PJP: Pnuemocystis jirovecii pneumonia; BAL: bronchoalveolar lavage; PCR: polymerase chain reaction; HIV: human immunodeficiency virus.



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