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

Eun-Jung Kim; Seung Jin Yoo; Gyung-Hoon Kang; Man Yong Hong; Jong Sam Hong; Dae Shick Ryu; Dae-Woon Eom; Bock Hyun Jung; Eun-Hee Song

doi:10.3947/ic.2012.44.1.40

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Kim, Yoo, Kang, Hong, Hong, Ryu, Eom, Jung, and Song: A Case of Multiple Pulmonary Nodular Pneumocystis jirovecii Pneumonia in an Acquired Immune Deficiency Syndrome Patient

Case Report

Infection & Chemotherapy

Infection & Chemotherapy 2012; 44(1): 40-43.

Published online: 29 February 2012

DOI: https://doi.org/10.3947/ic.2012.44.1.40

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

Eun-Jung Kim¹, Seung Jin Yoo¹, Gyung-Hoon Kang¹, Man Yong Hong¹, Jong Sam Hong¹, Dae Shick Ryu², Dae-Woon Eom³, Bock Hyun Jung¹, Eun-Hee Song¹

¹Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

²Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

³Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

Correspondence to Eun Hee Song, M.D. Department of Internal Medicine, Gangneung Asan Hospital, 415 Bangdong-ri, Sachen-myeoun, Gangneung 201-711, Korea. Tel: +82-33-610-3175, Fax: +82-33-610-4960, songeh@gnah.co.kr

Received 5 August 2011 Revised 5 September 2011 Accepted 15 September 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Multiple pulmonary nodules, Pneumocystis jirovecii pneumonia, Acquired Immune Deficiency Syndrome

Figures and Tables

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.

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.

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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