Lien experienced respiratory distress and failure, initially diagnosed with lung damage attributed to her lymphoma treatment, prolonged systemic corticosteroid use, and prophylactic medication for opportunistic infections. After nearly three weeks of care, she was discharged. However, a week later, fatigue and a cough producing white sputum led her to Tam Anh General Hospital in Hanoi.

Doctor Dang Thanh Do, from the Respiratory Department, noted that while Lien did not present with respiratory failure this time, she exhibited evident lung damage. Tests revealed infections including *Haemophilus influenzae*, RSV, Rhinovirus, the fungus *Pneumocystis jirovecii* (PCP), and cytomegalovirus (CMV) in her blood and bronchial fluid. Her lymphocyte and total white blood cell counts were significantly reduced, indicating severe immunodeficiency.

Although PCP infection is common in individuals with HIV, Lien tested HIV negative. Critically, her T-CD4 count was only 73 cells/mm³, a level comparable to patients in advanced stages of AIDS (AIDS is defined as T-CD4

"This patient presents with severe immunodeficiency, typically due to bone marrow dysfunction following lymphoma treatment", Doctor Do stated.

Tests confirmed the patient was co-infected with multiple pathogens. *Photo: Tam Anh General Hospital*

The doctors prescribed a combination of antibiotics, anti-CMV medication, and specific treatment for PCP. After two weeks of aggressive therapy, Lien's cough and sputum production resolved, and her blood CMV test was negative. She discontinued CMV medication, transitioned to a prophylactic PCP dose, and was discharged after three weeks.

One week later, a follow-up examination showed her lung lesions had improved by approximately 90% compared to her admission. Her white blood cell count normalized, and her bone marrow showed good recovery. Lien will continue long-term PCP prophylaxis.

Doctor Do advised patients to avoid contact with individuals with infectious diseases and to maintain PCP prophylaxis until their T-CD4 count consistently recovers above 200 cells/mm³ for at least six months. Regular follow-ups are also crucial.

Ha Nhung

*Patient's name has been changed.*