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Case Reports: Unusual presentation of more common disease/injury
Pneumocystis jirovecii pneumonia presenting as a large pulmonary mass in a patient with AIDS
  1. Taryn Bolling1,
  2. Stacy Gurevitz Beal2,
  3. Heather K Caulkins2 and
  4. Gary P Wang1
  1. 1Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
  2. 2Department of Pathology, University of Florida College of Medicine, Gainesville, FL, USA
  1. Correspondence to Dr Gary P Wang; gary.wang{at}medicine.ufl.edu

Abstract

Pneumocystis jirovecii pneumonia typically presents with diffuse bilateral infiltrates or ground-glass opacities. However, the radiographic pattern may be atypical. We report a case of a woman in her 40s who presented with multiple pulmonary masses and prolonged symptoms of non-productive cough, generalised weakness and fatigue. Serial chest CT performed prior to her presentation showed a large right lower lobe lung mass with multiple additional bilateral pulmonary nodules. Her workup revealed a new diagnosis of AIDS. Pathology of several CT-guided needle biopsies was consistent with Pneumocystis which was confirmed by microbial DNA sequencing. No additional pathogens were identified. Her clinical symptoms and radiographs improved significantly with trimethoprim-sulfamethoxazole and treatment of her HIV infection. Clinicians should evaluate for underlying immunodeficiency and seek infectious disease and pulmonary consultation early for consideration of alternative diagnoses when patients present with cough, dyspnoea and atypical chest radiographs, and initial pathological examination is unrevealing.

  • Infectious diseases
  • HIV / AIDS
  • Pneumonia (respiratory medicine)

https://doi.org/10.1136/bcr-2022-253563

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: TB, SGB, HKC and GPW. The following authors gave final approval of the manuscript: TB, SGB, HKC and GPW.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.