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Author Spotlight: A 3D Digital Model for the Diagnosis and Treatment of Pulmonary Nodules
Published on: May 19, 2023
Pneumocystis pneumonia with multiple nodules on computed tomography
Saori Ikeda1, Noriyo Yanagawa2
1Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Abstract:
As is well known to us that pneumocystis pneumonia (PCP) is one of opportunistic infections, there are not so many cases that computed tomography (CT) reveals multiple nodules, especially in non-HIV PCP. In this case, a 47-year-old female with acute myeloid leukemia has developed PCP. Two years prior to this presentation, she had undergone hematopoietic stem cell transplantation (HSCT) and had not experienced any recurrence. CT showed multiple nodules and segmental consolidation with subpleural sparing. Considering that it is refractory to levofloxacin, that β-d glucan is elevated, that PCP PCR was positive in the analysis of bronchial lavage fluid, and that other viral and fungal infections are unlikely, we clinically diagnosed as PCP. Although multiple nodules were thought to be atypical for PCP, CT performed 12 days after starting trimethoprim/sulfamethoxazole to confirm radiological efficacy demonstrated resolution of the nodules as well as consolidation. The significance of the present report lies in the fact that PCP should be kept in mind in the differential diagnosis when there are multiple nodules detected on CT in post-HSCT patients.
Insights
Pneumocystis pneumonia (PCP) can present as multiple nodules on CT scans, even in non-HIV patients. This case highlights PCP as a crucial differential diagnosis for multiple pulmonary nodules in patients post-hematopoietic stem cell transplantation.
Area of Science:
- Medical Imaging
- Infectious Diseases
- Hematology
Background:
- Pneumocystis pneumonia (PCP) is a significant opportunistic infection.
- Multiple nodules on computed tomography (CT) are atypical findings for PCP, particularly in non-human immunodeficiency virus (HIV) cases.
- Patients undergoing hematopoietic stem cell transplantation (HSCT) are at increased risk for opportunistic infections like PCP.
Purpose of the Study:
- To report a unique case of PCP presenting with multiple pulmonary nodules in a patient post-HSCT.
- To emphasize the importance of considering PCP in the differential diagnosis of multiple pulmonary nodules in immunocompromised patients.
- To illustrate the radiological resolution of atypical PCP findings following appropriate treatment.
Main Methods:
- Case report of a 47-year-old female with acute myeloid leukemia post-HSCT.
- Diagnostic workup included computed tomography (CT), serological markers (elevated β-d glucan), and molecular testing (PCP PCR on bronchial lavage fluid).
- Clinical diagnosis of PCP was made based on symptoms, imaging, and laboratory findings, despite atypical nodular presentation.
Main Results:
- CT revealed multiple nodules and segmental consolidation with subpleural sparing.
- The patient's condition was refractory to levofloxacin.
- PCP was confirmed by positive PCR on bronchial lavage fluid.
- Treatment with trimethoprim/sulfamethoxazole led to the resolution of both nodules and consolidation on follow-up CT.
Conclusions:
- Pneumocystis pneumonia (PCP) should be considered in the differential diagnosis of multiple pulmonary nodules detected on CT in patients who have undergone hematopoietic stem cell transplantation (HSCT).
- Atypical presentations of PCP, such as multiple nodules, can occur and resolve with appropriate antimicrobial therapy.
- This case underscores the need for a high index of suspicion for PCP in immunocompromised patients presenting with unusual radiological findings.
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