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.