A Double Threat in an Immunocompromised Patient: Coinfection With Pneumocystis jirovecii Pneumonia and Cytomegalovirus in Stomach Cancer

<i>Pneumocystis jirovecii</i> pneumonia (PCP) and cytomegalovirus (CMV) present significant threats as opportunistic infections among immunocompromised patients. The combination of these two infections can lead to dire clinical scenarios, particularly in those with weakened immune systems. We document a case of a patient battling advanced stomach cancer who was admitted with alarming symptoms, including persistent fever and severe respiratory distress. Having undergone multiple chemotherapy and immunotherapy cycles, patient's condition had deteriorated significantly. Initial management involved high-flow nasal cannula support; however, patient's respiratory status soon declined, progressing to acute respiratory distress syndrome, which necessitated the use of mechanical ventilation. A thorough bronchoscopy was conducted, and the subsequent bronchoalveolar lavage revealed a dual infection, confirming the presence of both PCP and CMV. Patient received a combination of trimethoprim-sulfamethoxazole and ganciclovir, specifically targeting the identified infections. To combat the hypoxia exacerbated by PCP, patient received a steroid. Remarkably, the patient was eventually weaned off the ventilator, marking a significant turn in their clinical course.