Kayik Selin Kestel, Acar Elif, Memis Leyla
Department of Pathology, Gazi University, School of Medicine, ANKARA, TURKEY.
Turk Patoloji Derg. 2020;1(1):246-250. doi: 10.5146/tjpath.2020.01480.
Pneumocystis jirovecii is a potentially life-threatening opportunistic pathogen particularly affecting the lungs, mainly in immunosuppressed individuals and HIV-infected patients with a low CD4 cell count. A 50-year-old man presented with a 1-week history of pleuritic chest pain and fever. He was also hypoxic with oxygen saturation of 86% on room air. Detailed clinical history revealed that he had fatigue, dyspnea, night sweats, generalized bone pain and a loss of about 10 kg in weight over the past six months without intention. Chest imaging showed diffuse bilateral infiltrates. Diagnostic bronchoscopy was performed. Transbronchial biopsy and bronchoalveolar lavage were received simultaneously. The presence of P. jirovecii was suspected in hematoxylin-eosin-stained slides, and Gomori's methenamine silver stain was used to confirm the diagnosis. A blood test revealed dyslipidemia, hypothyroidism, increased plasma levels of the gonadotropins and positive HIV antibodies with a CD4+ cell count of 48/μL. CMV co-infection was found with CMV viral load of 6738 copies/ml in plasma. Herein, we present a case with Pneumocystis jirovecii pneumonia (PCP) that led to a new diagnosis of Human immonudeficiency virus. As in our case, diagnosis of disease through the pathological examination of tissues (biopsy samples) or bodily fluids could lead to the recognition of an unrevealed HIV-infection.
耶氏肺孢子菌是一种潜在的危及生命的机会性病原体，主要影响肺部，多见于免疫抑制个体及CD4细胞计数低的HIV感染患者。一名50岁男性，有1周的胸膜炎性胸痛和发热病史。他还存在低氧血症，在室内空气中氧饱和度为86%。详细的临床病史显示，他在过去6个月中无明显诱因出现疲劳、呼吸困难、盗汗、全身骨痛及体重减轻约10kg。胸部影像学检查显示双侧弥漫性浸润。进行了诊断性支气管镜检查，同时获取了经支气管活检组织和支气管肺泡灌洗样本。苏木精-伊红染色切片中怀疑有耶氏肺孢子菌存在，采用Gomori六胺银染色确诊。血液检查显示血脂异常、甲状腺功能减退、促性腺激素血浆水平升高、HIV抗体阳性，CD4+细胞计数为48/μL。血浆中CMV病毒载量为6738拷贝/ml，发现合并CMV感染。在此，我们报告一例耶氏肺孢子菌肺炎（PCP）病例，该病例导致了人类免疫缺陷病毒的新诊断。正如我们的病例所示，通过组织（活检样本）或体液的病理检查诊断疾病可能会发现未被揭示的HIV感染。
