Yamao Sayaka, Jint Torahiko, Nishimura Naoki, Fujiwara Mieko, Suzuki Koyu, Chohnabayashi Naohiko
Division of Pulmonary Medicine, St. Luke's International Hospital.
Nihon Kokyuki Gakkai Zasshi. 2011 Mar;49(3):192-6.
A 24-year-old man was admitted with a 7-month history of non-productive cough, and recent onset of fever and progressive dyspnea. A chest X-ray film and computed tomography (CT) scan showed bilateral infiltrates that indicated pneumocystis pneumonia (PCP). A transbronchial lung biopsy specimen demonstrated Pneumocystis jirovecii infection on Grocott staining, and was positive for acid-fast bacilli without necrotizing granuloma, which indicated coinfection with both Pneumocystis jirovecii and Mycobacterium tuberculosis. A test for human immunodeficiency virus (HIV) infection was positive, and his CD4 + T-lymphocyte count was 92 cells per cubic millimeter. Chest CT findings and pathological findings.were atypical for active tuberculosis (TB). It is important that clinicians should be aware that HIV-infected patients may have concurrent pulmonary TB and PCP, because the diagnosis is difficult.
一名24岁男性因干咳7个月、近期发热及进行性呼吸困难入院。胸部X线片及计算机断层扫描（CT）显示双侧浸润影，提示肺孢子菌肺炎（PCP）。经支气管肺活检标本经格罗科特染色显示耶氏肺孢子菌感染，抗酸杆菌检测阳性但无坏死性肉芽肿，提示耶氏肺孢子菌与结核分枝杆菌合并感染。人类免疫缺陷病毒（HIV）感染检测呈阳性，其CD4 + T淋巴细胞计数为每立方毫米92个细胞。胸部CT表现及病理表现不典型，不符合活动性肺结核（TB）。临床医生应意识到HIV感染患者可能同时患有肺结核和PCP，因为诊断困难，这一点很重要。
