Yonsei Med J.  2016 Jul;57(4):1042-1046. 10.3349/ymj.2016.57.4.1042.

Unmasking Granulomatous Pneumocystis jirovecii Pneumonia with Nodular Opacity in an HIV-Infected Patient after Initiation of Antiretroviral Therapy

• Kim HW
• Heo JY
• Lee YM
• Kim SJ
• Jeong HW

• KMID: 2374142
• DOI: http://doi.org/10.3349/ymj.2016.57.4.1042

Abstract

Pneumocystis jirovecii pneumonia (PJP) in patients with HIV infection can, in rare cases, present with pulmonary nodules that histologically involve granulomatous inflammation. This report describes an intriguing case of granulomatous PJP with pulmonary nodules after commencing antiretroviral therapy (ART) in an HIV-infected patient without respiratory signs or symptoms. Diagnosis of granulomatous PJP was only achieved through thoracoscopic lung biopsy. This case suggests that granulomatous PJP should be considered in the differential diagnosis of pulmonary nodules in HIV-infected patients for unmasking immune reconstitution inflammatory syndrome manifestation after initiation of ART.

Keyword

Pneumocystis pneumonia; HIV infections; immune reconstitution inflammatory syndrome

Figure

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  Fig. 1 (A) Plain chest radiograph within normal limits. (B) Plain chest radiograph showing newly developed multiple nodular lesions in the right lower lung field. (C) Chest CT scans showing multiple nodular lesions in the right and left lower lobes of the lung.

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  Fig. 2 (A) Chronic granulomatous inflammation seen in the lung parenchyma, which filled with secretory materials in alveolar spaces (hematoxylin and eosin stain, ×200). (B) Pneumocystis jirovecii cysts, 5–8 µm in size, seen with an alveolar plaque stained using Gomori methenamine silver stain (×800).

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