Case presentation:
The patient, an 84-year-old male distinguished by his robust health and passion for cycling, has no significant medical history. He underwent a mastectomy for a 2cm hormone-receptor positive, HER2-positive, node-negative invasive ductal carcinoma. Based on the patient’s favorable health condition as indicated by a Balducci I classification during the oncogeriatric assessment, adjuvant chemotherapy was recommended at the multidisciplinary team meeting. The patient was tested negative for HIV serology before starting chemotherapy. Following current recommendations, treatment combining paclitaxel and trastuzumab was administered using the ”Tolaney regimen” (1). The dose of paclitaxel was reduced to 60mg/m² to minimize toxicity. Treatment was discontinued after the 9th course due to grade 3 asthenia. There was no lymphopenia observed in the blood count at this stage.
Nine days after the last administration of chemotherapy, the patient was admitted to the emergency department with fever and hypoxemic pneumonia. A CT-scan revealed diffuse interstitial pneumopathy (Figure 1.) and blood analysis showed a decreased lymphocyte count of 0.4 G/l. PCR forPneumocystis jirovecii was positive in the bronchoalveolar lavage fluid. Treatment with sulfamethoxazole/trimethoprim was initiated. Subsequently, the patient’s condition necessitated admission to the intensive care unit (ICU) and orotracheal intubation. Sequential administrations of atovaquone were performed.
Despite comprehensive interventions, the patient’s clinical status progressively deteriorated, leading to a consensus on therapeutic limitations. The patient passed away twenty-four hours thereafter.