Pneumocystis Pneumonia in a Non-HIV Patient With Advanced Liver Cirrhosis and No History of Immunosuppression: A Case Report

Pneumocystis pneumonia (PCP) is a critical opportunistic infection, typically seen in immunocompromised individuals. While its association with HIV is well known, there is a growing recognition of PCP in non-HIV patients, often linked to immunosuppressive therapy. However, cases of PCP in patients with liver cirrhosis and without iatrogenic immunosuppression remain underreported. We describe the case of a 72-year-old male patient with advanced liver cirrhosis (Child-Pugh score 12) secondary to metabolic dysfunction-associated steatohepatitis. He presented with fever and cough and was diagnosed with PCP based on characteristic imaging findings, elevated serum β-D-glucan, and a positive polymerase chain reaction test for <i>Pneumocystis jirovecii</i> in his sputum. Notably, he had no history of immunosuppressant use or HIV infection. Despite initial improvement in his respiratory condition with trimethoprim-sulfamethoxazole and corticosteroids, his hospital course was complicated by subsequent <i>Candida</i> bloodstream infection, ultimately leading to his death. This case highlights that advanced liver cirrhosis alone can constitute a significant risk factor for PCP and underscores the poor prognosis often associated with this condition. It emphasizes the importance of considering PCP in the differential diagnosis for patients with liver cirrhosis presenting with respiratory failure.