Infect Chemother.  2012 Feb;44(1):40-43. 10.3947/ic.2012.44.1.40.

A Case of Multiple Pulmonary Nodular Pneumocystis jirovecii Pneumonia in an Acquired Immune Deficiency Syndrome Patient

• Kim EJ
• Yoo SJ
• Kang GH
• Hong MY
• Hong JS
• Ryu DS
• Eom DW
• Jung BH
• Song EH

• KMID: 1782398
• DOI: http://doi.org/10.3947/ic.2012.44.1.40

Abstract

Pneumocystis jirovecii pneumonia (PCP) is a frequent manifestation of Acquired Immune Deficiency Syndrome (AIDS). The classic chest radiographic finding is perihilar ground glass opacities that may progress to more diffuse lung involvement. Atypical radiographic appearances include a normal chest film, lobar or segmental consolidation, cystic lesions, cavitation, pneumothorax, pleural effusion, and solitary or multiple pulmonary nodules. Although PCP is common in AIDS, presenting with nodular pulmonary densities is rare. We encountered the case of a 33-year-old man with AIDS whose chest radiography showed multiple bilateral nodular patterns suggestive of malignancy. We performed a transcutaneous lung biopsy and diagnosed him with PCP by Gomori methenamine-silver staining. Along with fungal and mycobacterial infections, intrathoracic Kaposi's sarcoma, and lymphoma, PCP should be considered in the differential diagnosis of nodular pulmonary disease in AIDS patients.

Keyword

Multiple pulmonary nodules; Pneumocystis jirovecii pneumonia; Acquired Immune Deficiency Syndrome

MeSH Terms

Acquired Immunodeficiency Syndrome
Adult
Biopsy
Diagnosis, Differential
Glass
Humans
Lung
Lung Diseases
Lymphoma
Multiple Pulmonary Nodules
Pleural Effusion
Pneumocystis
Pneumocystis jirovecii
Pneumonia
Pneumothorax
Sarcoma, Kaposi
Thorax

Figure

• 

  Figure 1 Posteroanterior chest radiograph view on admission shows multiple variable-sized lung nodules (black arrows) in both lung fields. The right aortic arch is noted with a white arrow.

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  Figure 2 Coronal conventional CT scans. (A) The initial CT scan shows multiple nodules and masses with cavitation (white arrow) or without cavitation (black arrow), or of the subpleural portion in the left upper lobe and right lower lobes. (B) CT scan after 22 days of PCP treatment shows paradoxical worsening of multiple lung nodules and masses. (C) CT scan after 75 days of PCP treatment shows decreased size of multiple lung nodules, masses, and the disappearance of cavitation.

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  Figure 3 (A) The specimen shows interstitial pneumonia with a few multinucleated cells (arrow), ill-formed granuloma and frothy intra-alveolar exudates (H&E stains, ×200). (B) Some cup or oval shaped organisms (arrow) are also noted in the exudates (GMS stain, ×400).

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