References
1. Reder AT, Centonze D, Naylor ML, Nagpal A, Rajbhandari R, Altincatal
A, et al. COVID-19 in Patients with Multiple Sclerosis: Associations
with Disease-Modifying Therapies. CNS Drugs. 2021;35(3):317-30.
2. Paybast S, Shahrab F, Hejazi SA. Recurrence of COVID-19 in a Patient
With NMO Spectrum Disorder While Treating With Rituximab: A Case Report
and Review of the Literature. Neurologist. 2021;26(6):281-3.
3. Tehrani S, Kashefizadeh A, Ziaie S, Keyvanfar A. Case report:
Pneumonia in a patient with combined variable immunodeficiency (CVID):
COVID-19 or Pneumocystis Pneumonia? Frontiers in Medicine. 2022:353.
4. Segal BM. The Diversity of Encephalitogenic CD4+ T Cells in Multiple
Sclerosis and Its Animal Models. J Clin Med. 2019;8(1).
5. Salzer J, Svenningsson R, Alping P, Novakova L, Björck A, Fink K, et
al. Rituximab in multiple sclerosis: A retrospective observational study
on safety and efficacy. Neurology. 2016;87(20):2074-81.
6. Tsai MJ, Chou CW, Lin FC, Chang SC. Pneumocystis jiroveci pneumonia
in patients with systemic lupus erythematosus after rituximab therapy.
Lupus. 2012;21(8):914-8.
7. Schauwvlieghe A, Rijnders BJA, Philips N, Verwijs R, Vanderbeke L,
Van Tienen C, et al. Invasive aspergillosis in patients admitted to the
intensive care unit with severe influenza: a retrospective cohort study.
Lancet Respir Med. 2018;6(10):782-92.
8. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features
of patients infected with 2019 novel coronavirus in Wuhan, China.
Lancet. 2020;395(10223):497-506.
9. Jeican, II, Inișca P, Gheban D, Tăbăran F, Aluaș M, Trombitas V, et
al. COVID-19 and Pneumocystis jirovecii Pulmonary Coinfection-The First
Case Confirmed through Autopsy. Medicina (Kaunas). 2021;57(4).
10. Menon AA, Berg DD, Brea EJ, Deutsch AJ, Kidia KK, Thurber EG, et al.
A Case of COVID-19 and Pneumocystis jirovecii Coinfection. Am J Respir
Crit Care Med. 2020;202(1):136-8.
11. Laurence J. Why Aren’t People Living with HIV at Higher Risk for
Developing Severe Coronavirus Disease 2019 (COVID-19)? AIDS Patient Care
STDS. 2020;34(6):247-8.
12. Szydłowicz M, Matos O. Pneumocystis pneumonia in the COVID-19
pandemic era: similarities and challenges. Trends Parasitol.
2021;37(10):859-62.
Figure 1: a) on admission day CT scan, there were multilobal bilateral
patchy consolidations, ground glass opacities and interlobular septal
thickening, with peripheral and peri-bronchovascular distribution.
“Crazy paving” is the dominant feature at right upper lobe; b) CT scan
right before bronchoscopy showed increased consolidations, ground glass
opacities and crazy paving in the same manner at multiple lung segments;
c and d) on discharge day CT scan, there were decreased consolidations
and change to ground glass opacities and crazy paving appearance at the
same involved segments. There was also evidence of “reverse halo” in
several segments and progression to fibrotic changes predominantly at
lung bases, as parenchymal and sub pleural bands; e) CT scan image, 3
months after discharge.