Ojuawo Olutobi, Htwe Thidar, Thein Onn Shaun, Sahal Adeel
Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Respiratory Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
BMJ Case Rep. 2021 Apr 27;14(4):e241061. doi: 10.1136/bcr-2020-241061.
Pneumocystis jirovecii pneumonia (PCP) is a potential life-threatening pulmonary infection which commonly manifests in immunosuppressed patients especially with HIV, with underlying malignancies, severe malnutrition as well as those on immunosuppressive treatments. There have been case reports of symptomatic PCP in individuals with a normally functioning immune system with typical clinical features and radiologic findings of bilateral and diffuse interstitial opacities. However, PCP in immunocompetent individuals presenting with lung nodules had been rarely reported. We report a 53-year-old immunocompetent gentleman who presented with subacute cough, progressive shortness of breath and radiographic findings of multiple lung nodules with central cavitation. The diagnosis of PCP was made by detection of PCP DNA PCR in bronchoalveolar lavage sample following fibreoptic bronchoscopy. This case also highlights the atypical radiographic findings of multiple cavitating lung nodules as a presentation of PCP in an immunocompetent patient.
耶氏肺孢子菌肺炎（PCP）是一种潜在的危及生命的肺部感染，常见于免疫抑制患者，尤其是艾滋病毒感染者、患有潜在恶性肿瘤者、严重营养不良者以及接受免疫抑制治疗的患者。有病例报告称，免疫系统正常的个体也会出现有症状的PCP，具有典型的临床特征和双侧弥漫性间质混浊的影像学表现。然而，免疫功能正常的个体出现肺结节性PCP的情况鲜有报道。我们报告一例53岁免疫功能正常的男性，表现为亚急性咳嗽、进行性气短，影像学检查发现多个伴有中央空洞的肺结节。经纤维支气管镜检查后，通过检测支气管肺泡灌洗样本中的PCP DNA PCR确诊为PCP。该病例还突出了多个空洞性肺结节这种非典型影像学表现作为免疫功能正常患者PCP的一种呈现形式。
