Tuberculosis and Respiratory Diseases

  • 제67권2호
  • /
  • Pages.127-130
  • /
  • 2009
  • /
  • 1738-3536(pISSN)
  • /
  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
권호 표지
DOI QR코드

DOI QR Code

Pneumocystis jiroveci Pneumonia Mimicking Miliary Tuberculosis in a Kidney Transplanted Patient

  • Jung, Ju Young (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Rhee, Kyoung Hoon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Koo, Dong Hoe (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, I-Nae (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shim, Tae Sun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2006.09.19
  • 심사 : 2006.10.09
  • 발행 : 2009.08.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Bilateral interstitial infiltration in chest radiography, which may be fine granular, reticular or of ground glass opacity, is the typical radiographic findings of Pneumocystis jiroveci pneumonia. Recently, atypical radiographic features, including cystic lung disease, spontaneous pneumothorax or nodular opacity, have been reported intermittently in patients with P. jiroveci pneumonia. We report the case of a 29-year-old woman with a transplanted kidney whose simple chest radiography and HRCT scan showed numerous miliary nodules in both lungs, mimicking miliary tuberculosis (TB). Under the presumptive diagnosis of miliary TB, empirical anti-TB medication was started. However, Grocott methenamine silver nitrate staining of a transbronchial lung biopsy tissue revealed P. jiroveci infection without evidence of TB. These findings suggest that even in TB-endemic area other etiology such as P. jiroveci as well as M. tuberculosis should be considered as an etiology of miliary lung nodules in mmunocompromised patients.

키워드

참고문헌

  1. Bartlett JG. Pneumonia in the patient with HIV infection. Infect Dis Clin North Am 1998;12:807-20 https://doi.org/10.1016/S0891-5520(05)70211-7
  2. McGuinness G, Gruden JF. Viral and Pneumocystis carinii infections of the lung in the immunocompromised host. J Thorac Imaging 1999;14:25-36 https://doi.org/10.1097/00005382-199901000-00003
  3. Flannery MT, Quiroz E, Grundy LS, Brantley S. Pneumocystis carinii pneumonia with an atypical granulomatous response. South Med J 1996;89:409-10 https://doi.org/10.1097/00007611-199604000-00011
  4. Ong EL, Murray H, Ellis ME. Miliary Pneumocystis carinii pneumonia in acquired immunodeficiency syndrome. Int J STD AIDS 1992;3:54-5 https://doi.org/10.1177/095646249200300114
  5. Kennedy CA, Goetz MB. Atypical roentgenographic manifestations of Pneumocystis carinii pneumonia. Arch Intern Med 1992;152:1390-8 https://doi.org/10.1001/archinte.152.7.1390
  6. Hazzan M, Copin MC, Pruvot FR, Codaccioni MX, Dracon M, Lelievre G, et al. Lung granulomatous pneumocystosis after kidney transplantation: an uncommon complication. Transplant Proc 1997;29:2409 https://doi.org/10.1016/S0041-1345(97)00424-7
  7. Leroy X, Copin MC, Ramon P, Jouet JP, Gosselin B. Nodular granulomatous Pneumocystis carinii pneumonia in a bone marrow transplant recipient: case report. APMIS 2000;108:363-6 https://doi.org/10.1034/j.1600-0463.2000.d01-69.x
  8. Cohen WN, McAlister WH. Pneumocystis carinii pneumonia: report of four cases. Am J Roentgenol Radium Ther Nucl Med 1963;89:1032-7
  9. Lee JY, Lee KS, Jung KJ, Han J, Kwon OJ, Kim J, et al. Pulmonary tuberculosis: CT and pathologic correlation. J Comput Assist Tomogr 2000;24:691-8 https://doi.org/10.1097/00004728-200009000-00005
  10. Kroe DM, Kirsch CM, Jensen WA. Diagnostic strategies for Pneumocystis carinii pneumonia. Semin Respir Infect 1997;12:70-8