BACKGROUND: Pneumocystis jiroveci pneumonia (PCP) – formerly known as Pneumocyctis carinii pneumonia – with newly diagnosed AIDS is an uncommon presentation in people over 50 years of age. A high level of suspicion is required for this diagnosis when an elderly patient with pneumonia is not responding to broad-spectrum antibiotic treatment.

CASE REPORT: We describe the case of a 63-year-old woman who presented with dyspnea, cough, and significant hypoxemia requiring high-flow oxygen supplement with bilateral lung infiltrates, treated with broad-spectrum antibiotics for a presumed diagnosis of pneumonia. The patient demonstrated slow clinical improvement. A diagnostic bronchoscopy with transbronchial biopsy was done, which revealed unexpected findings of Pneumocystis organisms on GMS stain. The patient tested positive for HIV and was found to have a low CD4 of 47. She was treated for Pneumocystis jiroveci pneumonia (PCP) and recovered accordingly.

CONCLUSIONS: It is essential to remember that HIV and the associated opportunistic infections can be very easily overlooked in the elderly. Taking a sexual history can be challenging, especially in the older population, but it should be performed. Keep in mind that aged people can get infected with HIV at an earlier stage in life and remain in latent phase for up to 15 years without specific symptoms.

Keywords: AIDS-Related Opportunistic Infections, Dyspnea, Pneumocystis carinii