Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Single Nodular Opacity of Granulomatous Pneumocystis Jirovecii Pneumonia in an Asymptomatic Lymphoma Patient

  • Kim, Hyun Soo (Department of Diagnostic Radiology, Kyung Hee University Hospital) ;
  • Shin, Kyung Eun (Department of Diagnostic Radiology, Kyung Hee University Hospital) ;
  • Lee, Ju-Hie (Department of Pathology, Kyung Hee University Hospital)
  • Received : 2014.06.22
  • Accepted : 2015.01.03
  • Published : 2015.04.01
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Abstract

The radiologic findings of a single nodule from Pneumocystis jirovecii pneumonia (PJP) have been rarely reported. We described a case of granulomatous PJP manifesting as a solitary pulmonary nodule with a halo sign in a 69-year-old woman with diffuse large B cell lymphoma during chemotherapy. The radiologic appearance of the patient suggested an infectious lesion such as angioinvasive pulmonary aspergillosis or lymphoma involvement of the lung; however, clinical manifestations were not compatible with the diseases. The nodule was confirmed as granulomatous PJP by video-assisted thoracoscopic surgery biopsy.

Keywords

References

  1. Boiselle PM, Crans CA Jr, Kaplan MA. The changing face of Pneumocystis carinii pneumonia in AIDS patients. AJR Am J Roentgenol 1999;172:1301-1309 https://doi.org/10.2214/ajr.172.5.10227507
  2. Marchiori E, Muller NL, Soares Souza A Jr, Escuissato DL, Gasparetto EL, Franquet T. Pulmonary disease in patients with AIDS: high-resolution CT and pathologic findings. AJR Am J Roentgenol 2005;184:757-764 https://doi.org/10.2214/ajr.184.3.01840757
  3. Pastores SM, Garay SM, Naidich DP, Rom WN. Review: pneumothorax in patients with AIDS-related Pneumocystis carinii pneumonia. Am J Med Sci 1996;312:229-234 https://doi.org/10.1016/S0002-9629(15)41822-1
  4. Hartz JW, Geisinger KR, Scharyj M, Muss HB. Granulomatous pneumocystosis presenting as a solitary pulmonary nodule. Arch Pathol Lab Med 1985;109:466-469
  5. Chang H, Shih LY, Wang CW, Chuang WY, Chen CC. Granulomatous Pneumocystis jiroveci pneumonia in a patient with diffuse large B-cell lymphoma: case report and review of the literature. Acta Haematol 2010;123:30-33 https://doi.org/10.1159/000261020
  6. Bier S, Halton K, Krivisky B, Leonidas J. Pneumocystis carinii pneumonia presenting as a single pulmonary nodule. Pediatr Radiol 1986;16:59-60 https://doi.org/10.1007/BF02387509
  7. Hartel PH, Shilo K, Klassen-Fischer M, Neafie RC, Ozbudak IH, Galvin JR, et al. Granulomatous reaction to pneumocystis jirovecii: clinicopathologic review of 20 cases. Am J Surg Pathol 2010;34:730-734
  8. Bondoc AY, White DA. Granulomatous Pneumocystis carinii pneumonia in patients with malignancy. Thorax 2002;57:435-437 https://doi.org/10.1136/thorax.57.5.435
  9. Totet A, Duwat H, Daste G, Berry A, Escamilla R, Nevez G. Pneumocystis jirovecii genotypes and granulomatous pneumocystosis. Med Mal Infect 2006;36:229-231 https://doi.org/10.1016/j.medmal.2005.11.015
  10. Travis WD, Pittaluga S, Lipschik GY, Ognibene FP, Suffredini AF, Masur H, et al. Atypical pathologic manifestations of Pneumocystis carinii pneumonia in the acquired immune deficiency syndrome. Review of 123 lung biopsies from 76 patients with emphasis on cysts, vascular invasion, vasculitis, and granulomas. Am J Surg Pathol 1990;14:615-625 https://doi.org/10.1097/00000478-199007000-00002
  11. Otahbachi M, Nugent K, Buscemi D. Granulomatous Pneumocystis jiroveci Pneumonia in a patient with chronic lymphocytic leukemia: a literature review and hypothesis on pathogenesis. Am J Med Sci 2007;333:131-135 https://doi.org/10.1097/00000441-200702000-00014
  12. Kumar N, Bazari F, Rhodes A, Chua F, Tinwell B. Chronic Pneumocystis jiroveci presenting as asymptomatic granulomatous pulmonary nodules in lymphoma. J Infect 2011;62:484-486 https://doi.org/10.1016/j.jinf.2011.04.008
  13. Goodman PC. Pneumocystis carinii pneumonia. J Thorac Imaging 1991;6:16-21 https://doi.org/10.1097/00005382-199109000-00006
  14. Kuhlman JE, Fishman EK, Siegelman SS. Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology 1985;157:611-614 https://doi.org/10.1148/radiology.157.3.3864189
  15. Primack SL, Hartman TE, Lee KS, Muller NL. Pulmonary nodules and the CT halo sign. Radiology 1994;190:513-515 https://doi.org/10.1148/radiology.190.2.8284408
  16. Parron M, Torres I, Pardo M, Morales C, Navarro M, Martinez-Schmizcraft M. [The halo sign in computed tomography images: differential diagnosis and correlation with pathology findings]. Arch Bronconeumol 2008;44:386-392
  17. Pinto PS. The CT Halo Sign. Radiology 2004;230:109-110 https://doi.org/10.1148/radiol.2301020649

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