Cargando…

Granulomatous Pneumocystis jiroveci Pneumonia in an HIV-Positive Patient on Antiretroviral Therapy: A Diagnostic Challenge

Human Immunodeficiency Virus (HIV)-related Opportunistic Infections (OI), including Pneumocystis jiroveci pneumonia (PCP), have become much less commonplace with anti-retroviral therapy (ART). Despite this, OIs are still common and it is important to remain vigilant for their presence and be aware o...

Descripción completa

Detalles Bibliográficos
Autores principales: Diaz-Abad, Montserrat, Robinett, Kathryn S., Lasso-Pirot, Anayansi, Legesse, Teklu B., Khambaty, Mariam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Bentham Science Publishers 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227459/
https://www.ncbi.nlm.nih.gov/pubmed/34249178
http://dx.doi.org/10.2174/1874306402115010019
_version_ 1783712527621816320
author Diaz-Abad, Montserrat
Robinett, Kathryn S.
Lasso-Pirot, Anayansi
Legesse, Teklu B.
Khambaty, Mariam
author_facet Diaz-Abad, Montserrat
Robinett, Kathryn S.
Lasso-Pirot, Anayansi
Legesse, Teklu B.
Khambaty, Mariam
author_sort Diaz-Abad, Montserrat
collection PubMed
description Human Immunodeficiency Virus (HIV)-related Opportunistic Infections (OI), including Pneumocystis jiroveci pneumonia (PCP), have become much less commonplace with anti-retroviral therapy (ART). Despite this, OIs are still common and it is important to remain vigilant for their presence and be aware of how ART and OI chemoprophylaxis may lead to atypical disease presentations. We present the case of a 51-year-old woman with HIV and CD4+ T helper lymphocytes cell count > 200 cells/ul on both ART and trimethoprim/sulfamethoxazole prophylaxis who presented with cavitating lung masses, mediastinal lymphadenopathy and pleural effusions. Negative bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx) prompted a second diagnostic procedure with a transthoracic core needle biopsy; the final diagnosis was granulomatous PCP. This case showcases a very rare presentation of PCP, with both large cavitating lung masses on imaging and granulomatous reaction on pathology, as well as the challenge of a potentially missed diagnosis with negative BAL and TBBx requiring transthoracic core needle biopsy for a final diagnosis.
format Online
Article
Text
id pubmed-8227459
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Bentham Science Publishers
record_format MEDLINE/PubMed
spelling pubmed-82274592021-07-09 Granulomatous Pneumocystis jiroveci Pneumonia in an HIV-Positive Patient on Antiretroviral Therapy: A Diagnostic Challenge Diaz-Abad, Montserrat Robinett, Kathryn S. Lasso-Pirot, Anayansi Legesse, Teklu B. Khambaty, Mariam Open Respir Med J Respiratory Medicine Human Immunodeficiency Virus (HIV)-related Opportunistic Infections (OI), including Pneumocystis jiroveci pneumonia (PCP), have become much less commonplace with anti-retroviral therapy (ART). Despite this, OIs are still common and it is important to remain vigilant for their presence and be aware of how ART and OI chemoprophylaxis may lead to atypical disease presentations. We present the case of a 51-year-old woman with HIV and CD4+ T helper lymphocytes cell count > 200 cells/ul on both ART and trimethoprim/sulfamethoxazole prophylaxis who presented with cavitating lung masses, mediastinal lymphadenopathy and pleural effusions. Negative bronchoalveolar lavage (BAL) and transbronchial biopsy (TBBx) prompted a second diagnostic procedure with a transthoracic core needle biopsy; the final diagnosis was granulomatous PCP. This case showcases a very rare presentation of PCP, with both large cavitating lung masses on imaging and granulomatous reaction on pathology, as well as the challenge of a potentially missed diagnosis with negative BAL and TBBx requiring transthoracic core needle biopsy for a final diagnosis. Bentham Science Publishers 2021-06-18 /pmc/articles/PMC8227459/ /pubmed/34249178 http://dx.doi.org/10.2174/1874306402115010019 Text en © 2021 Diaz-Abad et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Respiratory Medicine
Diaz-Abad, Montserrat
Robinett, Kathryn S.
Lasso-Pirot, Anayansi
Legesse, Teklu B.
Khambaty, Mariam
Granulomatous Pneumocystis jiroveci Pneumonia in an HIV-Positive Patient on Antiretroviral Therapy: A Diagnostic Challenge
title Granulomatous Pneumocystis jiroveci Pneumonia in an HIV-Positive Patient on Antiretroviral Therapy: A Diagnostic Challenge
title_full Granulomatous Pneumocystis jiroveci Pneumonia in an HIV-Positive Patient on Antiretroviral Therapy: A Diagnostic Challenge
title_fullStr Granulomatous Pneumocystis jiroveci Pneumonia in an HIV-Positive Patient on Antiretroviral Therapy: A Diagnostic Challenge
title_full_unstemmed Granulomatous Pneumocystis jiroveci Pneumonia in an HIV-Positive Patient on Antiretroviral Therapy: A Diagnostic Challenge
title_short Granulomatous Pneumocystis jiroveci Pneumonia in an HIV-Positive Patient on Antiretroviral Therapy: A Diagnostic Challenge
title_sort granulomatous pneumocystis jiroveci pneumonia in an hiv-positive patient on antiretroviral therapy: a diagnostic challenge
topic Respiratory Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227459/
https://www.ncbi.nlm.nih.gov/pubmed/34249178
http://dx.doi.org/10.2174/1874306402115010019
work_keys_str_mv AT diazabadmontserrat granulomatouspneumocystisjirovecipneumoniainanhivpositivepatientonantiretroviraltherapyadiagnosticchallenge
AT robinettkathryns granulomatouspneumocystisjirovecipneumoniainanhivpositivepatientonantiretroviraltherapyadiagnosticchallenge
AT lassopirotanayansi granulomatouspneumocystisjirovecipneumoniainanhivpositivepatientonantiretroviraltherapyadiagnosticchallenge
AT legesseteklub granulomatouspneumocystisjirovecipneumoniainanhivpositivepatientonantiretroviraltherapyadiagnosticchallenge
AT khambatymariam granulomatouspneumocystisjirovecipneumoniainanhivpositivepatientonantiretroviraltherapyadiagnosticchallenge