Bleiweiss I J, Jagirdar J S, Klein M J, Siegel J L, Krellenstein D J, Gribetz A R, Strauchen J A
Department of Pathology, Mt Sinai Medical Center, New York, New York 10029.
Chest. 1988 Sep;94(3):580-3. doi: 10.1378/chest.94.3.580.
Pneumocystis carinii pneumonia is a frequent manifestation of the acquired immune deficiency syndrome (AIDS). It usually presents radiologically as diffuse bilateral infiltrates and histologically as a foamy, eosinophilic intra-alveolar exudate containing the organisms' cysts. We recently studied two rare cases of P carinii pneumonia presenting as pulmonary nodules on chest x-ray films in two patients with AIDS. The corresponding histologies were a combination of the usual intra-alveolar pattern, with an alveolar and interstitial granulomatous appearance. Pneumocystis carinii was present in both areas and was the only organism found in the tissues examined. A third case presented with the more common radiographic appearance but also had a granulomatous histology. We conclude that P carinii pneumonia should be considered in the differential diagnosis of pulmonary nodules in immunocompromised patients and that pathologists should be aware of the possibility of a granulomatous reaction to this organism.
卡氏肺孢子虫肺炎是获得性免疫缺陷综合征（艾滋病）的常见表现。其影像学表现通常为双侧弥漫性浸润，组织学表现为含有病原体囊肿的泡沫状、嗜酸性肺泡内渗出物。我们最近研究了两例罕见的卡氏肺孢子虫肺炎病例，两名艾滋病患者胸部X线片表现为肺结节。相应的组织学表现为常见的肺泡内模式与肺泡和间质肉芽肿外观的组合。两个区域均存在卡氏肺孢子虫，且是所检查组织中唯一发现的病原体。第三例表现为更常见的影像学表现，但组织学上也有肉芽肿形成。我们得出结论，免疫功能低下患者肺结节的鉴别诊断应考虑卡氏肺孢子虫肺炎，病理学家应意识到对该病原体发生肉芽肿反应的可能性。
