Abstract
We herein report a case of pneumocystis pneumonia development following radiation therapy and chemotherapy for metastatic lesions to the neck and pulmonary regions originating as a head and neck carcinoma. Pneumocystis pneumonia is an opportunistic disease which occurs in immunocompromised patients. The patient, a 75-year-old male, had been under radiation therapy since January 1997 for squamous cell carcinoma of the left oropharynx. The patient has undergone several resections and radiation therapies for recurrences and the progress had been under strict observation. He was hospitalized on July 7th, 2003, for metastasis to the left cervical lymph node. Although pulmonary metastasis was identified, pulmonary metastatectomy was not performed. Neck dissection was performed on July 14th with preservation of the left accessory nerve. Radiation therapy was conducted along with two sessions of chemotherapy following surgery. From September 16th, one week after the second chemotherapy, the patient complained of high-grade fever of 39°C or greater with decrease in neutrophilic leukocyte count. Chest radiograph examination taken on September 25th revealed interstitial shadows. Since pneumocystis pneumonia was suspected, trimethoprim-sulfamethoxazole and steroid were orally administered from that day. Subsequently, the indication values improved rapidly and returned to normal values on October 6th. Thereafter, the patient had shortperiod hospitalizations on several occasions for chemotherapy. However, he died on April 3rd, 2005. He was under a home healthcare program and his ADL was preserved until his last hospitalization.
