Taeb Abdalsamih M, Sill Joshua M, Derber Catherine J, Hooper Michael H
1 Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
2 Division of Infectious Diseases, Eastern Virginia Medical School, Norfolk, VA, USA.
Int J STD AIDS. 2018 Dec;29(14):1451-1453. doi: 10.1177/0956462418787603. Epub 2018 Aug 16.
Although Pneumocystis jiroveci pneumonia (PCP) is a frequent manifestation of acquired immune deficiency syndrome (AIDS), the granulomatous form is uncommon. Here, we present an unusual case of granulomatous PCP consequent to immune reconstitution inflammatory syndrome (IRIS) after highly active antiretroviral therapy. A 36-year-old woman with human immunodeficiency virus (HIV) presented with cough and dyspnea that were attributed to typical PCP associated with AIDS. She was successfully treated with antibiotic, steroid, and antiretroviral therapies. After six months, however, she presented with consolidating lung lesions caused by bronchial obstruction from PCP granulomatous disease. Although antibiotics were ineffective, the effectiveness of steroid therapy suggested a diagnosis of granulomatous IRIS caused by persistent PCP antigens. Physicians should strongly suspect PCP in HIV-positive patients with nodular lung lesions and must remain aware that these lesions, if immune in origin, might not respond to antimicrobial therapy.
尽管耶氏肺孢子菌肺炎（PCP）是获得性免疫缺陷综合征（AIDS）的常见表现，但肉芽肿形式并不常见。在此，我们报告一例在高效抗逆转录病毒治疗后因免疫重建炎症综合征（IRIS）导致的肉芽肿性PCP罕见病例。一名36岁的人类免疫缺陷病毒（HIV）感染女性出现咳嗽和呼吸困难，归因于与AIDS相关的典型PCP。她接受抗生素、类固醇和抗逆转录病毒治疗后成功治愈。然而，六个月后，她出现了由PCP肉芽肿病导致支气管阻塞引起的肺部实变病变。尽管抗生素治疗无效，但类固醇治疗有效提示诊断为由持续存在的PCP抗原引起的肉芽肿性IRIS。医生应高度怀疑HIV阳性且有肺部结节病变的患者患有PCP，并且必须意识到这些病变如果是免疫源性的，可能对抗菌治疗无反应。
