References
1. Reder AT, Centonze D, Naylor ML, Nagpal A, Rajbhandari R, Altincatal A, et al. COVID-19 in Patients with Multiple Sclerosis: Associations with Disease-Modifying Therapies. CNS Drugs. 2021;35(3):317-30.
2. Paybast S, Shahrab F, Hejazi SA. Recurrence of COVID-19 in a Patient With NMO Spectrum Disorder While Treating With Rituximab: A Case Report and Review of the Literature. Neurologist. 2021;26(6):281-3.
3. Tehrani S, Kashefizadeh A, Ziaie S, Keyvanfar A. Case report: Pneumonia in a patient with combined variable immunodeficiency (CVID): COVID-19 or Pneumocystis Pneumonia? Frontiers in Medicine. 2022:353.
4. Segal BM. The Diversity of Encephalitogenic CD4+ T Cells in Multiple Sclerosis and Its Animal Models. J Clin Med. 2019;8(1).
5. Salzer J, Svenningsson R, Alping P, Novakova L, Björck A, Fink K, et al. Rituximab in multiple sclerosis: A retrospective observational study on safety and efficacy. Neurology. 2016;87(20):2074-81.
6. Tsai MJ, Chou CW, Lin FC, Chang SC. Pneumocystis jiroveci pneumonia in patients with systemic lupus erythematosus after rituximab therapy. Lupus. 2012;21(8):914-8.
7. Schauwvlieghe A, Rijnders BJA, Philips N, Verwijs R, Vanderbeke L, Van Tienen C, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med. 2018;6(10):782-92.
8. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
9. Jeican, II, Inișca P, Gheban D, Tăbăran F, Aluaș M, Trombitas V, et al. COVID-19 and Pneumocystis jirovecii Pulmonary Coinfection-The First Case Confirmed through Autopsy. Medicina (Kaunas). 2021;57(4).
10. Menon AA, Berg DD, Brea EJ, Deutsch AJ, Kidia KK, Thurber EG, et al. A Case of COVID-19 and Pneumocystis jirovecii Coinfection. Am J Respir Crit Care Med. 2020;202(1):136-8.
11. Laurence J. Why Aren’t People Living with HIV at Higher Risk for Developing Severe Coronavirus Disease 2019 (COVID-19)? AIDS Patient Care STDS. 2020;34(6):247-8.
12. Szydłowicz M, Matos O. Pneumocystis pneumonia in the COVID-19 pandemic era: similarities and challenges. Trends Parasitol. 2021;37(10):859-62.
Figure 1: a) on admission day CT scan, there were multilobal bilateral patchy consolidations, ground glass opacities and interlobular septal thickening, with peripheral and peri-bronchovascular distribution. “Crazy paving” is the dominant feature at right upper lobe; b) CT scan right before bronchoscopy showed increased consolidations, ground glass opacities and crazy paving in the same manner at multiple lung segments; c and d) on discharge day CT scan, there were decreased consolidations and change to ground glass opacities and crazy paving appearance at the same involved segments. There was also evidence of “reverse halo” in several segments and progression to fibrotic changes predominantly at lung bases, as parenchymal and sub pleural bands; e) CT scan image, 3 months after discharge.