Related Experiment Videos

Chronic Pneumocystis jiroveci presenting as asymptomatic granulomatous pulmonary nodules in lymphoma

Neelam Kumar1, Farid Bazari, Anita Rhodes

  • 1Clinical Infection Unit, St George's Hospital, Blackshaw Road, London SW17 0QT, UK. neelamkumar@doctors.org.uk

The Journal of Infection
|May 20, 2011
PubMed

Insights

A rare case of chronic Pneumocystis jiroveci pneumonia presented as asymptomatic pulmonary nodules in a lymphoma patient. This highlights unusual clinical and radiological findings of this opportunistic infection.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Oncology

Background:

  • Pneumocystis jiroveci pneumonia (PJP) typically presents with respiratory symptoms in immunocompromised individuals.
  • Follicular lymphoma patients undergoing chemotherapy, especially with agents like Rituximab, are at increased risk for opportunistic infections.
  • Chronic PJP is uncommon, with most cases presenting acutely.

Observation:

  • A patient with follicular lymphoma on chemotherapy developed multiple persistent pulmonary nodules over 12 months.
  • The patient remained asymptomatic throughout the 12-month period despite the persistent pulmonary findings.
  • Histological and radiological examinations revealed granulomatous changes consistent with chronic PJP.

Findings:

  • This case represents the first documented instance of chronic P. jiroveci infection manifesting as asymptomatic, multiple, persistent granulomatous pulmonary nodules.
  • The atypical presentation challenges the typical understanding of P. jiroveci pneumonia's clinical and radiological features.
  • The combination of follicular lymphoma, specific chemotherapy, and this unusual P. jiroveci manifestation is unique.

Implications:

  • This case expands the spectrum of P. jiroveci infection presentations, particularly in the context of specific immunosuppressive therapies.
  • It underscores the importance of considering atypical P. jiroveci manifestations in immunocompromised patients, even in the absence of symptoms.
  • Further research may be warranted to understand the pathogenesis of chronic, asymptomatic P. jiroveci pulmonary disease in specific patient populations.

Related Concept Videos

Pneumonia I: Introduction01:30

Pneumonia I: Introduction

Pneumonia is an acute respiratory infection that targets the lungs, specifically the alveoli. These tiny air sacs, essential for oxygen exchange, become engorged with pus and fluid, severely hindering breathing, decreasing oxygen absorption, and causing significant pain and discomfort during respiration.
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
Pneumonia I: Introduction01:29

Pneumonia I: Introduction

Pneumonia is an infection of the lower respiratory tract that leads to inflammation of the lung parenchyma, often resulting in the accumulation of inflammatory exudate in the alveoli and airways. Unlike the watery, low-protein fluid exudate in pulmonary edema, the exudate in this case is a thick fluid rich in immune cells, proteins, and debris produced during infection and inflammation.This impairs gas exchange and can lead to consolidation of lung tissue. The infection may be caused by a...
Chronic Obstructive Pulmonary Disease IV: Clinical Manifestations01:19

Chronic Obstructive Pulmonary Disease IV: Clinical Manifestations

Chronic Obstructive Pulmonary Disease, or COPD, is a long-term condition marked by persistent and only partially reversible airflow limitation. It involves two overlapping conditions—chronic bronchitis and emphysema—which often co-appear but differ in dominant symptoms and underlying mechanisms.Chronic Bronchitis FeaturesChronic bronchitis presents with a persistent productive cough and thick, sometimes purulent mucus due to airway inflammation, enlarged mucus glands, and goblet cell...
Pulmonary Tuberculosis II01:28

Pulmonary Tuberculosis II

Tuberculosis, or TB, is a bacterial infectious disease caused by Mycobacterium tuberculosis. While its primary impact is on the lungs, leading to pulmonary tuberculosis, it can also affect various other organs, a condition referred to as extrapulmonary tuberculosis.
Here is a detailed explanation of its pathophysiology:
Transmission: The process begins when a person inhales droplet nuclei containing M. tuberculosis. These are typically released into the air when an individual with pulmonary or...
Pneumonia II: Pathophysiology01:29

Pneumonia II: Pathophysiology

The pathophysiology of pneumonia involves the following steps:
Atypical Pneumonia01:14

Atypical Pneumonia

Atypical pneumonia, often caused by Mycoplasma pneumoniae, is a form of pulmonary infection that differs from the classical presentation of bacterial pneumonia in both its cause and clinical symptoms. Mycoplasma pneumoniae is a pleomorphic bacterium notable for its lack of a rigid cell wall. This structural characteristic imparts resistance to beta-lactam antibiotics and significantly influences the bacterium’s behavior within the human host.Other pathogens responsible for the disease include...