Digital necrosis and disseminated Pneumocystis carinii infection after aerosolized pentamidine prophylaxis
Embolic Pneumocystis carinii should be considered a potential cause of digital ischemia in patients with AIDS, particularly those with previous pneumocystis pneumonia. Pneumocystis carinii pneumonia occurs with unusually high frequency in patients with human immunodeficiency virus (HIV) infection and contributes substantially to the morbidity and mortality associated with the acquired immunodeficiency syndrome (AIDS). A feature of infection with this pathogen is that disease is almost always confined to the lung, with extrapulmonary spread rarely reported. As a result, recent strategies to prevent pneumocystis infection without causing systemic toxicity have focused on aerosolized drug delivery to the lungs. This case not only again underscores the severity of systemic disease capable of being caused by pneumocystis infection, but must also heighten concern that dissemination may be recognized more commonly as aerosolized pentamidine becomes more widely used.