Unusual Presentation of Pneumocystis carinii Pneumonia

A previously healthy 51-year-old man presented with weight loss and poor appetite of 2 months' duration. He was heterosexual and had many sexual partners. Except for a temperature of 38.3°C (100.9°F) and left basal rhonchi, results of physical examination were normal. A chest radiograph and CT scan, as seen here, showed large cavitary lesions in the lower left lobe.

The patient remained febrile despite empiric antimicrobial therapy. Bronchoscopy was performed, and specimens from transbronchial biopsy and bronchoalveolar lavage were positive for Pneumocystis carinii. The patient was seropositive for HIV, and his CD4 count was 14/µL (normal range, 400 to 1,770/µL). His condition improved following oral treatment with a trimethoprim-sulfamethoxazole combination, and there were no recurrences of pneumonia within the ensuing 9 months. P carinii pneumonia (PCP) is the most common pulmonary infection in patients with AIDS, writes Dr Samer Alkhuja of Greenwich, Conn. Atypical radiologic manifestations of PCP include nodules, hilar masses, pneumatoceles, and spontaneous pneumothorax.¹ In this case, a highly atypical radiographic presentation and the finding of PCP led to the diagnosis of AIDS.

REFERENCE:
1. Kennedy CA, Goetz MB. Atypical roentgenographic manifestions of Pneumocystis carinii pneumonia. Arch Intern Med. 1992;152:1390-1398.