Presentation
Human immunodeficiency virus (HIV), chronic lymphocytic leukemia (CLL) with hypoxemia and fever.
Patient Data
Frontal and lateral chest radiographs demonstrate reduced lung volume with bilateral predominantly peripheral lung opacities appear pleural-based with sharp lateral margin and ill-defined inner margins highly suggestive of calcified pleural plaques. Mild patchy opacification noted in the right lower lung zone.
Follow-up frontal and lateral chest radiographs demonstrate a dramatic worsening with evidence of bilateral patchy opacities.
CT scan of the chest demonstrates bilateral patchy consolidative and diffuse ground glass opacities associated with minor central lobular septal thickening predominantly in the upper lung zones giving crazy paving appearance. There is relative sparing of the lung periphery. Minor bilateral pleural effusions or pleural thickening. Few small borderline mediastinal and hilar lymph nodes are seen. Bilateral pleural plaques that are partially calcified.
Case Discussion
Bronchiolar-alveolar lavage was negative for malignancy. Pneumocystis jirovecii present. No other fungal organisms present. No cellular changes of viral infection.
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