A Persistent Cough and an Unexplained Diagnosis - Summary - MDSpire

A Persistent Cough and an Unexplained Diagnosis

NEJM case details the diagnostic evaluation of an 80-year-old woman with weeks of respiratory symptoms, weight loss, and diffuse ground-glass opacities on chest CT.

  • By

  • Olivia Anderson

  • February 2, 2026

  • 3 min

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Objective:

To present a case of advanced HIV-1 infection complicated by Pneumocystis jirovecii pneumonia and cryptococcal pneumonia in an elderly patient, highlighting the significance of early diagnosis in older adults.

Key Findings:
  • Patient presented with cough, dyspnea, fever, weight loss, and hypoxemia over 8 weeks.
  • Chest CT showed bilateral ground-glass opacities, significant for P. jirovecii pneumonia.
  • HIV-1 viral load was 223,000 copies/mL with a CD4 count of 33 cells/µL, indicating advanced disease.
  • Pneumocystis jirovecii pneumonia and cryptococcal pneumonia were confirmed, emphasizing the need for thorough diagnostic evaluation.
Interpretation:

The case highlights the critical importance of HIV screening in older adults, particularly those presenting with respiratory symptoms and risk factors, to facilitate early diagnosis and treatment.

Limitations:
  • Serum cryptococcal antigen tests were negative despite the presence of cryptococcal pneumonia, which may complicate diagnosis.
  • The case may not represent typical presentations of HIV-related pneumonia, limiting generalizability.
Conclusion:

Pneumocystis jirovecii pneumonia is a leading opportunistic infection in advanced HIV, emphasizing the urgent need for risk assessment and early HIV screening in older adults.

Original Source(s)

A Persistent Cough and an Unexplained Diagnosis

  • by Olivia Anderson

  • February 2, 2026

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