Extracorporeal Membrane Oxygenation for Pneumocystis jirovecii Pneumonia in a Child With Multisystem Langerhans Cell Histiocytosis.

Background

Pneumocystis jirovecii pneumonia (PJP) is a rapidly progressive and potentially fatal opportunistic infection in non-HIV immunocompromised children. Mortality is particularly high when PJP progresses to acute respiratory distress syndrome (ARDS). The role of extracorporeal membrane oxygenation (ECMO) in this setting remains limited to select reports.

Case presentation

We report a 3-year-old boy with multisystem Langerhans cell histiocytosis receiving vinblastine and corticosteroids who developed severe PJP during consolidation therapy. Despite early initiation of high-dose trimethoprim-sulfamethoxazole, adjunctive corticosteroids, and escalation to invasive mechanical ventilation, he developed refractory hypoxemic and hypercapnic respiratory failure. Bronchoalveolar lavage multiplex polymerase chain reaction confirmed Pneumocystis jirovecii with concurrent Klebsiella pneumoniae . In the absence of hemodynamic compromise or multiorgan dysfunction, venovenous (V-V) ECMO was initiated as rescue support. Rapid improvement in gas exchange allowed decannulation on day 6 and extubation by day 8. Radiologic resolution occurred within 2 weeks. The child completed antimicrobial therapy, resumed maintenance chemotherapy, and remains well at 10-month follow-up on secondary PJP prophylaxis.

Conclusion

This case underscores the importance of early recognition and aggressive supportive care. In selected patients with isolated, potentially reversible respiratory failure, timely initiation of V-V ECMO can be lifesaving and may facilitate recovery while definitive antimicrobial therapy takes effect.