Pneumocystis jiroveci pneumonia complicating immune reconstitution inflammatory syndrome
Presentation
3-4 week history of increasing shortness of breath recent travel to South East Asia. History of psoriasis, psoriatic arthritis, on methotrexate
Patient Data
Subtle reticular opacities within both midzones.
Minor patchy ground-glass density within both lungs.
Widespread air-space opacity within both lungs.
Widespread areas of consolidation and ground-glass density within both lungs.
Case Discussion
The patient was diagnosed with HIV on admission.
Initial sputum tests were positive for Pneumocystis jiroveci DNA by PCR - confirming initial chest imaging findings as Pneumocystis jiroveci pneumonia.
Antiretroviral therapy (ART) therapy was commenced 5 days after presentation and initial imaging.
There was a clinical deterioration 10 days post admission, at which point CXR and CT were performed. The deterioration of the patient's clinical and imaging findings correlated to an increase in the patient's CD4 count.
This pattern is consistent with immune reconstitution inflammatory syndrome (IRIS).
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