When Antiretroviral Therapy Is Not Enough: A Case Series of Pneumocystis Pneumonia With Pulmonary Complications in HIV-Positive Patients.

Pulmonary opportunistic infections remain a major cause of morbidity in people living with HIV (PLHIV), especially with poor antiretroviral therapy (ART) adherence or comorbidities. Pneumocystis jirovecii pneumonia (PJP) is a frequent and life-threatening infection that may be complicated by bacterial superinfections or post-tubercular sequelae. We describe two HIV-positive adults with severe pulmonary involvement. The first, a 38-year-old man with interrupted ART, presented with hemoptysis, fever, and oral ulcers. Cluster of differentiation 4 (CD4) count was 80 cells/mm³; sputum showed P. jirovecii cysts, and culture grew Pseudomonas aeruginosa. High-resolution computed tomography (HRCT) revealed fibrocavitary post-tubercular changes with superinfection. The second, a 55-year-old woman with diabetes and hypertension on ART, developed hypoxemic respiratory failure; sputum confirmed PJP with bilateral infiltrates on imaging. Both improved with high-dose co-trimoxazole, corticosteroids, ART, and supportive care. These cases highlight the persistent burden of PJP in PLHIV, the risks of poor ART adherence, and the role of timely diagnosis and comprehensive management in improving outcomes.