Korean J Radiol.  2015 Apr;16(2):440-443. 10.3348/kjr.2015.16.2.440.

Single Nodular Opacity of Granulomatous Pneumocystis Jirovecii Pneumonia in an Asymptomatic Lymphoma Patient

• Kim HS
• Shin KE
• Lee JH

• KMID: 2070188
• DOI: http://doi.org/10.3348/kjr.2015.16.2.440

Abstract

The radiologic findings of a single nodule from Pneumocystis jirovecii pneumonia (PJP) have been rarely reported. We described a case of granulomatous PJP manifesting as a solitary pulmonary nodule with a halo sign in a 69-year-old woman with diffuse large B cell lymphoma during chemotherapy. The radiologic appearance of the patient suggested an infectious lesion such as angioinvasive pulmonary aspergillosis or lymphoma involvement of the lung; however, clinical manifestations were not compatible with the diseases. The nodule was confirmed as granulomatous PJP by video-assisted thoracoscopic surgery biopsy.

Keyword

Granulomatous Pneumocystis jirovecii pneumonia; Nodular opacity; Lymphoma

MeSH Terms

Aged
Antibodies, Monoclonal, Murine-Derived/adverse effects/therapeutic use
Antineoplastic Agents/adverse effects/therapeutic use
Antineoplastic Combined Chemotherapy Protocols/adverse effects/therapeutic use
Biopsy/methods
Cyclophosphamide/adverse effects/therapeutic use
Doxorubicin/adverse effects/therapeutic use
Female
Humans
Lymphoma, Large B-Cell, Diffuse/drug therapy/microbiology
Pneumocystis jirovecii/pathogenicity
Pneumonia, Pneumocystis/*diagnosis/*radiography
Positron-Emission Tomography
Prednisone/adverse effects/therapeutic use
Solitary Pulmonary Nodule/*microbiology
Thoracic Surgery, Video-Assisted
Tomography, X-Ray Computed
Vincristine/adverse effects/therapeutic use
Antibodies, Monoclonal, Murine-Derived
Antineoplastic Agents
Cyclophosphamide
Doxorubicin
Prednisone
Vincristine

Figure

• 

  Fig. 1 69-year-old woman with granulomatous PJP. Chest CT shows small subpleural nodule in right lower lobe (A) and shows high uptake on PET-CT (B). Follow-up CT taken 10 days later shows progression of nodule with peripheral ground glass opacity (C). Histopathologic features of granulomatous PJP show chronic granulomatous inflammation (white arrows) with foamy exudates (black arrowheads) (D, hematoxylin and eosin stain, × 400) and Pneumocystis cysts (white arrows) (E, Gomori methenamine silver stain, × 400). CT = computed tomography, PET-CT = positron emission tomography-computed tomography, PJP = Pneumocystis jirovecii pneumonia

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