Tuberc Respir Dis TRD Tuberculosis and Respiratory Diseases 1738-3536 2005-6184 The Korean Academy of Tuberculosis and Respiratory Diseases 10.4046/trd.2010.68.2.97 Case Report A Case of Pneumocystis Pneumonia Mimicking Acute Eosinophilic Pneumonia in a Patient with AIDS Lee Bo Ra M.D. Kim Hyun Kook M.D. Park I Nae M.D. Choi Sang Bong M.D. Jung Hoon M.D. Lee Hyun Kyung M.D. Lee Sung Soon M.D. Lee Young Min M.D. Lee Hyuk Pyo M.D. Choi Soo Jeon M.D. Yum Ho-Kee M.D. Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea. Address for correspondence: Ho-Kee Yum, M.D. Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, 85, Jeo-dong 2-ga, Jung-gu, Seoul 100-032, Korea. Phone: 82-2-2270-0004, Fax: 82-2-2285-2286, pulho@korea.com 02 2010 28 02 2010 68 2 97 100 09 10 2009 15 12 2009 Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved. 2010

73-year-old man was admitted with a sudden onset of dyspnea. He had never smoked. The chest radiograph and computed tomography revealed bilateral ground glass opacity and an enlarging perihilar consolidation with lymphadenopathies. There was a higher percentage of eosinophils (72%) in the bronchoalveolar lavage fluid (BALF) than normal. The patient was diagnosed with acute eosinophilic pneumonia and managed with steroid. Pneumocystis pneumonia (PCP) was diagnosed by an examination of the BALF, and the patient was treated with trimethoprim-sulphamethoxazole. The patient tested positive to the HIV antibody and the peripheral blood CD-4 positive lymphocyte count was only 33/µL. The percentage of eosinophils in the BALF can increase in some cases of PCP that is complicated with AIDS. Only a few cases of eosinophilic pneumonia associated with PCP pneumonia have been reported in patients with AIDS but there are no case reports in Korea. This case highlights the need to consider PCP when the percentage of eosinophils in the BALF is elevated.

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Chest PA at emergency room (A) and 14th hospital day (B). The bilateral hilar enlargement and ground glass opecities with increased interstitial markings were showed and improved 2 weeks later.

Chest computed tomography on admission. The bilateral perihilar ground glass opecities with increased interstitial markings were showed.

Bronchoalveolar lavage fluid. (A) The nucleus of eosinophils contains one to two lobes. The cytoplasm is abundant with a full complement of bright reddish specific granules (Giemsa stain, ×400). (B) Pneumocystis jirovecci aggregates of many discoid shaped cysts with thick, darkly stained, silver-positive capsule and a central tiny dot (GMS stain, ×400).