Pneumocystis jirovecii pneumonia

Case contributed by Dr Yune Kwong

Presentation

Known HIV, recently off retroviral medication with a 3 week history of SOB.

Patient Data

Age: 35 years
Gender: Male
X-ray

Diffuse or perihilar fine reticular and ill-defined ground glass opacities. 

CT findings include scattered or diffuse ground glass opacities, consolidation and thickening of interlobular septa. Ground glass opacities may predominate in the early stages of the disease, with linear opacities in the more chronic stage. 

Case Discussion

CXR is normal at presentation in up to 6% of symptomatic patients. Hilar or mediastinal lymphadenopathy is rare, as is pleural fluid in the absence of extrapulmonary pneumocystosis.

In practice, the disease affects both airways and interstitium. Normal CT is good evidence that PCP is not the cause of symptoms. 

One third of patients with PCP develop pneumatocoeles, with predilection for upper lobes, especially in patients treated with aerosolized pentamidine. Spontaneous pneumothorax is a complication.

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Case information

rID: 26697
Published: 3rd Jan 2014
Last edited: 25th Nov 2019
System: Chest
Inclusion in quiz mode: Included

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