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Shehbaz M, Aslam S, Arslan M, Nizamuddin S, Ali S, Abbas S. Clinical Characteristics and Outcomes of Pneumocystis jirovecii Pneumonia in Cancer Patients From a Tertiary Care Hospital. Cureus 2023; 15:e51291. [PMID: 38283518 PMCID: PMC10822671 DOI: 10.7759/cureus.51291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/30/2024] Open
Abstract
Objective To investigate the predisposing factors, disease course, potential complications, role of primary prophylaxis, and overall outcomes of Pneumocystis jirovecii pneumonia (PJP) in cancer patients. Methods The study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan. We analyzed the medical records of cancer patients diagnosed with PJP from January 2018 to December 2022 and collected data about demographic characteristics, clinical presentation, predisposing factors, treatment, complications, and mortality rates. We used SPSS 20 (IBM Corp., Armonk, NY, USA) for data analysis. Results Out of 84 patients, 59.5% (n=50) were males and most of the patients belonged to the age group 41 to 65 years. Sixty-seven point nine percent (67.9%; n=57) of patients had underlying hematological malignancy, including three bone marrow transplant recipients while 32.2% (n=27) of patients had underlying solid organ malignancy. We also observed the use of corticosteroids, rituximab, and fludarabine as predisposing factors in 15% (n=13), 27% (n=23), and 3.7%(n=03) of patients, respectively. The most common symptoms were dyspnea (88%; n=74), followed by fever (69%; n=58) and cough (69%; n=58). The former one was more prevalent in hematological malignancy patients as compared to the solid organ tumor group (p-value 0.001). We noted respiratory failure (45.2%; n=38), ICU stay (52.38%; n=44), death (32%; n=27), and shock (10.7% n=9) as the most common PJP-related complications. Moreover, all these complications were more frequent in hematological malignancy patients. We also observed that only three patients developed PJP while on adequate primary prophylaxis for this condition. The overall all-cause one-month mortality was 32% (n=27). Conclusion Cancer patients, especially those with hematological malignancies presenting with symptoms suggestive of PJP, need careful evaluation and preemptive treatment as PJP-related mortality is higher in cancer patients. Early diagnosis and treatment in this population can be lifesaving. Moreover, all cancer patients should receive PJP prophylaxis when indicated.
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Affiliation(s)
- Muhammad Shehbaz
- Internal Medicine and Infectious Disease, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Seemal Aslam
- Internal Medicine and Infectious Disease, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Arslan
- Internal Medicine and Infectious Disease, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Summiya Nizamuddin
- Microbiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sajid Ali
- Internal Medicine and Infectious Disease, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Salma Abbas
- Internal Medicine and Infectious Disease, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Baek YJ, Kim K, Nam BD, Jung J, Lee E, Noh H, Kim TH. Late-Onset Granulomatous Pneumocystis jirovecii Pneumonia in A Renal Transplant Recipient: A Clinical Grand Round Conference Case in 2022. Infect Chemother 2023; 55:309-316. [PMID: 37794576 PMCID: PMC10551715 DOI: 10.3947/ic.2023.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023] Open
Abstract
Late-onset Pneumocystis jirovecii pneumonia (PCP) can be developed in solid organ transplant (SOT) patients. Granulomatous P. jirovecii pneumonia (GPCP) can occur in immunocompromised patients, but has rarely been reported in SOT recipients. The diagnosis of GPCP is difficult since the sensitivity of sputum and bronchoalveolar lavage is low and atypical patterns are shown. A 60-year-old man, who had undergone renal transplantation 24 years ago presented with nodular and patchy lung lesions. He was asymptomatic and stable. After empirical treatment with a fluoroquinolone, the condition partially resolved but relapsed 4 months later. The pulmonary nodule was resected, and GPCP was confirmed. The pathogenesis of GPCP remains unclear, but in SOT recipients presenting with an atypical lung pattern, GPCP should be considered. This case was discussed at the Grand Clinical Ground of the Korean Society of Infectious Disease conference on November 3, 2022.
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Affiliation(s)
- Yae Jee Baek
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kyeongmin Kim
- Department of Pathology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Bo Da Nam
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jongtak Jung
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyunjin Noh
- Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
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Ibrahim A, Chattaraj A, Iqbal Q, Anjum A, Rehman MEU, Aijaz Z, Nasir F, Ansar S, Zangeneh TT, Iftikhar A. Pneumocystis jiroveci
Pneumonia: A Review of Management in Human Immunodeficiency Virus (HIV) and Non-HIV Immunocompromised Patients. Avicenna J Med 2023; 13:23-34. [PMID: 36969352 PMCID: PMC10038753 DOI: 10.1055/s-0043-1764375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
Pneumocystis jirovecii
pneumonia is an opportunistic fungal infection that was mainly associated with pneumonia in patients with advanced human immunodeficiency virus (HIV) disease. There has been a decline in
Pneumocystis jirovecii
pneumonia incidence in HIV since the introduction of antiretroviral medications. However, its incidence is increasing in non-HIV immunocompromised patients including those with solid organ transplantation, hematopoietic stem cell transplantation, solid organ tumors, autoimmune deficiencies, and primary immunodeficiency disorders. We aim to review and summarize the etiology, epidemiology, clinical presentation, diagnosis, and management of
Pneumocystis jirovecii
pneumonia in HIV, and non-HIV patients. HIV patients usually have mild-to-severe symptoms, while non-HIV patients present with a rapidly progressing disease. Induced sputum or bronchoalveolar lavage fluid can be used to make a definitive diagnosis of
Pneumocystis jirovecii
pneumonia. Trimethoprim-sulfamethoxazole is considered to be the first-line drug for treatment and has proven to be highly effective for
Pneumocystis jirovecii
pneumonia prophylaxis in both HIV and non-HIV patients. Pentamidine, atovaquone, clindamycin, and primaquine are used as second-line agents. While several diagnostic tests, treatments, and prophylactic regimes are available at our disposal, there is need for more research to prevent and manage this disease more effectively.
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Affiliation(s)
- Atif Ibrahim
- North Mississippi Medical Center, Tupelo, Mississippi, United States
| | - Asmi Chattaraj
- University of Pittsburgh Medical Center, McKeesport, Pennsylvania, United States
| | - Qamar Iqbal
- TidalHealth, Salisbury, Maryland, United States
| | - Ali Anjum
- King Edward Medical University, Lahore, Pakistan
| | | | | | | | - Sadia Ansar
- Rawal Institute of Health Sciences, Islamabad, Pakistan
| | - Tirdad T. Zangeneh
- Division of Infectious Diseases, Department of Medicine, University of Arizona, Tucson, Arizona, United States
| | - Ahmad Iftikhar
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, United States
- Address for correspondence Ahmad Iftikhar, MD Department of Medicine, University of Arizona1525N. Campbell Avenue, PO Box 245212, Tucson, AZ 85724
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Necrotizing Granulomatous Pneumocystis Infection Presenting as a Solitary Pulmonary Nodule: A Case Report and Review of the Literature. Case Rep Pulmonol 2022; 2022:7481636. [PMID: 35936826 PMCID: PMC9352445 DOI: 10.1155/2022/7481636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/16/2022] [Indexed: 11/24/2022] Open
Abstract
Pneumocystis jirovecii is an opportunistic fungus that is classically associated with pneumonia in immunocompromised patients, particularly those with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). However, this infection is now more commonly seen in those with malignancy, particularly lymphoproliferative disorders. Classic image findings with Pneumocystis jirovecii pneumonia (PJP) include bilateral ground-glass opacities with or without cyst formation. Up to 5% of patients with PJP may present with atypical image findings, specifically nodular opacities or masses thought to represent granulomatous inflammation. The differential diagnosis for a new solitary pulmonary nodule in an immunocompromised patient is broad. One must first rule out a recurrence of malignancy or new primary malignancy. In our patient's case, two nondiagnostic bronchoscopies with EBUS-TBNA eventually led to a surgical resection, which revealed a diagnosis of nodular necrotizing granulomatous Pneumocystis jirovecii. The diagnostic yield from EBUS is not well established, and most cases require surgical biopsy for definitive diagnosis. Further data regarding the use of EBUS-TBNA in diagnosing granulomatous PJP is needed.
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Kobayashi M, Tsubata Y, Shiratsuki Y, Hotta T, Isobe T. Multiple Mass Lesions in Pneumocystis Pneumonia. Cureus 2022; 14:e21590. [PMID: 35228948 PMCID: PMC8867965 DOI: 10.7759/cureus.21590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/05/2022] Open
Abstract
We encountered a case of pneumocystis pneumonia (PCP) presenting with multiple mass lesions in a human immunodeficiency virus (HIV)-negative patient. Diagnosis of PCP before bronchoscopy was difficult because chest computed tomography (CT) findings were atypical of PCP and a serum (1,3)-β-D-glucan concentration was within normal limits. Bronchoscopic biopsy and Grocott’s staining enabled the diagnosis of PCP. PCP can show various patterns on chest CT images, depending on the immune status of the host. In high-risk patients, such as those who are immunocompromised, bronchoscopy should be performed with suspected cases of PCP, even if CT imaging does not show typical ground-glass opacity.
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Shin SR, Kim TS, Han J. CT Findings of Granulomatous Pneumocystis jiroveci Pneumonia in a Patient with Multiple Myeloma. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:218-223. [PMID: 36237342 PMCID: PMC9238193 DOI: 10.3348/jksr.2021.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 11/15/2022]
Abstract
Although the typical CT findings of Pneumocystis jiroveci pneumonia (PJP) include diffuse or multifocal areas of ground-glass opacities in both lungs, it can also rarely manifest as multiple pulmonary nodules. We report a rare case of atypical PJP in an immunocompromised patient with multiple myeloma, presenting as widespread ground-glass opacities and multiple necrotic subpleural nodules in both lungs on CT, which proved to be granulomatous PJP on percutaneous transthoracic needle biopsy.
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Affiliation(s)
- So Ra Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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7
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Pulmonary cannonballs in a patient with Acquired Immunodeficiency Syndrome (AIDS). IDCases 2021; 25:e01229. [PMID: 34367917 PMCID: PMC8326746 DOI: 10.1016/j.idcr.2021.e01229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022] Open
Abstract
Pneumocystis jirovecii pneumonia (PJP) remains one of the most common and life-threatening complications in patients with AIDS. PJP typically presents subacutely with a dry cough, shortness of breath with exertion, fever, and bilateral ground-glass opacities on imaging. However, atypical imaging findings have been reported including cysts, isolated lymphadenopathy, and small to large nodules. This case highlights the importance of considering unusual presentations of a relatively common entity in order to prevent delays in diagnosis and treatment.
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8
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Pyden AD, VanderLaan PA, Alonso CD, Riedel S. Atypical histologic presentation of Pneumocystis pneumonia as granulomatous lung nodules. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Dai SY, Chiang CT, Chen PC, Chen YY. Granulomatous Pneumocystis jirovecii mimics pulmonary metastasis in rectal cancer. Kaohsiung J Med Sci 2020; 37:74-75. [PMID: 33058528 DOI: 10.1002/kjm2.12312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shuo-Ying Dai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chun-Ting Chiang
- Division of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Po-Chuan Chen
- Division of Colorectal Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
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10
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CT Halo sign: A systematic review. Eur J Radiol 2020; 124:108843. [PMID: 32007819 DOI: 10.1016/j.ejrad.2020.108843] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The CT Halo sign or Halo sign (HS) refers to ground-glass opacity surrounding a nodule or mass in the lung parenchyma. We conducted a systematic review to find the etiological associations of HS. We also evaluated the diagnostic performances of HS for invasive fungal infections (IFI) in immunosuppressed patients. METHOD The systematic review was conducted as per PRISMA guidelines. We searched the PubMed and EMBASE database till June 2018 without any restrictions. Only case reports, case series and original articles published in English language were included. A database created from the electronic searches was compiled and subsequent analysis was done. [PROSPERO registration: CRD42018094739] RESULTS: 168 studies were eligible, which included 51 case reports, 15 prospective studies, 102 retrospective studies. A total of 1977 patients (out of 6371) with HS were identified with age range between <1year-94years. The most common diagnosis in the immunosuppressed, mixed, immunocompetent and not specified groups were IFI (86.9 %, n = 1194), Cryptococcosis (51.6 %, n = 124), Cryptococcosis (40 %, n = 20) and lung neoplasms (81.8 %, n = 36) respectively. 14 studies (11 retrospective, 3 prospective) were included in quantitative analysis. The pooled sensitivity(sn), specificity(sp) and odd's ratio (OR) of HS for diagnosing IFI were 50.4 %, 91 % and 6.61 respectively. Also, HS could not reliably differentiate IPA from mucormycosis in the pooled analysis. CONCLUSIONS HS can be seen in a large number of diverse conditions both in immunosuppressed and immunocompetent population. In immunosuppressed patients HS is specific for IFI but cannot rule it out. Additionally, it cannot reliably distinguish between IPA and mucormycosis.
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Cereser L, Dallorto A, Candoni A, Volpetti S, Righi E, Zuiani C, Girometti R. Pneumocystis jirovecii pneumonia at chest High-resolution Computed Tomography (HRCT) in non-HIV immunocompromised patients: Spectrum of findings and mimickers. Eur J Radiol 2019; 116:116-127. [PMID: 31153552 DOI: 10.1016/j.ejrad.2019.04.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/21/2019] [Accepted: 04/30/2019] [Indexed: 01/08/2023]
Abstract
Pneumocystis jirovecii pneumonia (PJP) has emerged as a main issue in non Human Immunodeficiency Virus (HIV) immunocompromised hosts, exposing patients to high mortality rates, especially when the diagnosis is delayed. Since microbiological confirmation is often unfeasible or difficult to obtain, High-resolution Computed Tomography (HRCT) represents a main tool for guiding the diagnosis in the appropriate clinical scenario. Nevertheless, radiologists must be aware that PJP at HRCT is a multifaceted process, with a variety of common and less frequent findings, along with a broad spectrum of infectious (e.g., viral and certain fungal and bacterial pneumonias) and non-infectious (e.g., pulmonary oedema, diffuse alveolar haemorrhage, and drug toxicity) differential diagnoses. In this review we resume background clinical information on PJP in non-HIV immunocompromised patients, illustrate both typical and less frequent HRCT findings, and present the spectrum of infectious and non-infectious mimickers at HRCT, highlighting the similarities with PJP and providing clues for the differential diagnosis.
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Affiliation(s)
- Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Integrata di Udine, p.le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Anna Dallorto
- Institute of Radiology, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Integrata di Udine, p.le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Anna Candoni
- Division of Haematology and Stem Cell Transplantation, University Hospital of Udine, Azienda Sanitaria Universitaria Integrata di Udine, p.le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Stefano Volpetti
- Division of Haematology and Stem Cell Transplantation, University Hospital of Udine, Azienda Sanitaria Universitaria Integrata di Udine, p.le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Elda Righi
- Infectious Diseases, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Integrata di Udine, p.le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Integrata di Udine, p.le S. Maria della Misericordia 15, 33100, Udine, Italy.
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Integrata di Udine, p.le S. Maria della Misericordia 15, 33100, Udine, Italy.
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Kim B, Kim J, Paik SS, Pai H. Atypical Presentation of Pneumocystis jirovecii Infection in HIV Infected Patients: Three Different Manifestations. J Korean Med Sci 2018; 33:e115. [PMID: 29629518 PMCID: PMC5890084 DOI: 10.3346/jkms.2018.33.e115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/08/2017] [Indexed: 12/04/2022] Open
Abstract
Advances in the treatment and prevention of Pneumocystis jirovecii infection (PJI) in human immunodeficiency virus (HIV) patients decreased incidence and mortality dramatically, however, it may be associated with an increased frequency of unusual manifestation such as cystic formation, pneumothorax, focal infiltration, nodular formation, or extrapulmonary lesions. We report three cases of PJI with atypical manifestations. Each case demonstrates different clinical features: multiple nodular pulmonary lesion (32-year-old man with abnormal chest X-ray finding), subpleural mass-like lesion (43-year-old man with left visual loss and right pleuritic chest pain), and extrapulmonary mass-like lesions in the liver, lymph nodes, and small bowel (39-year-old man with cough, sputum, and dyspnea). P. jirovecii was confirmed in all 3 cases and they were treated well. It is necessary to understand that PJI shows variable clinical features.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Sam Paik
- Department of Pathology, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Pingili CS, Sivapalan V. PJP granuloma in an Immune competent host: Case report and literature review. IDCases 2017; 10:32-34. [PMID: 28856102 PMCID: PMC5565774 DOI: 10.1016/j.idcr.2017.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/15/2017] [Accepted: 06/26/2017] [Indexed: 11/25/2022] Open
Abstract
PJP (Pneumocystis jirovecii) is a fungal agent by taxonomy. Ones considered a protozoan, it is now recognized as fungi based on ribosomal RNA and other gene sequence homologies, the composition of their cell walls, and structure of key enzymes. This organism generally affects immunocompromised hosts with a CD4 count <200 or <15%.Review of literature does support a rare occurrence of PJP infections in immunocompetent hosts.PJP can occur at normal CD 4 levels.
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Affiliation(s)
- Chandra S Pingili
- Columbia University medical center, The Affiliation at Harlem hospital, New York, USA.,Lincoln medical & mental health center, New York, USA
| | - Vel Sivapalan
- Columbia University medical center, The Affiliation at Harlem hospital, New York, USA.,Lincoln medical & mental health center, New York, USA
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Pneumocystis Pneumonia Presenting as an Enlarging Solitary Pulmonary Nodule. Case Rep Infect Dis 2016; 2016:1873237. [PMID: 27648318 PMCID: PMC5018315 DOI: 10.1155/2016/1873237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/03/2016] [Accepted: 08/14/2016] [Indexed: 11/17/2022] Open
Abstract
Pneumocystis pneumonia is a life threatening infection that usually presents with diffuse bilateral ground-glass infiltrates in immunocompromised patients. We report a case of a single nodular granulomatous Pneumocystis pneumonia in a male with diffuse large B-cell lymphoma after R-CHOP therapy. He presented with symptoms of productive cough, dyspnea, and right-sided pleuritic chest pain that failed to resolve despite treatment with multiple antibiotics. Chest X-ray revealed right lower lobe atelectasis and CT of chest showed development of 2 cm nodular opacity with ground-glass opacities. Patient underwent bronchoscopy and biopsy that revealed granulomatous inflammation in a background of organizing pneumonia pattern with negative cultures. Respiratory symptoms resolved but the solitary nodular opacity increased in size prompting a surgical wedge resection which revealed granulomatous Pneumocystis pneumonia infection. This case is the third documented report of Pneumocystis pneumonia infection within a solitary pulmonary nodule in an individual with hematologic neoplasm. Although Pneumocystis pneumonia most commonly occurs in patients with HIV/acquired immunodeficiency syndrome and with diffuse infiltrates, the diagnosis should not be overlooked when only a solitary nodule is present.
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