PMC8227459_01
Admission Computed Tomography scan (CT) of the chest, showing: (A) Pleural based large cavitating lung mass in the left upper lobe measuring 4.2 x 4.2 cm; and (B) Multiple masses and nodules scattered throughout both lungs. CT of the chest 3 months later, showing: (C) Persistent but much smaller cavitating left upper lobe nodule, and (D) Nearly complete resolution of the previous nodules and masses, with multiple peripheral bilateral sub-cm non-calcified pulmonary nodules.
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F1
There were also bilateral pleural effusions with associated compressive atelectasis of the lower lobes and fibrotic changes in the left apical region, (Fig. 1). CT of the chest 3 months later revealed nearly complete resolution of the previous findings, with a significantly improved cavitating left upper lobe nodule, multiple peripheral bilateral sub-cm non calcified pulmonary nodules, and resolution of bilateral pleural effusions and mediastinal lymphadenopathy (Fig. 1).
Transthoracic core needle biopsies histology. (A) Granulomatous inflammation with epithelioid cell aggregates and lymphoplasmacytic infiltrates. The granulomas in some areas are not well-formed (Hematoxylin and Eosin, Low magnification). (B) Granulomatous inflammation with aggregates of epithelioid cells and scattered Langhans type multinucleated giant cells (Hematoxylin and Eosin, medium magnification). (C) Necrotic center of the granuloma with surrounding loose epithelioid cell aggregates (Hematoxylin and Eosin, High magnification). (D) Scattered cysts of Pneumocystis jiroveci in the center of necrotic granuloma (Gomori methenamine silver, high magnification).
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Pathology revealed lung parenchyma and bronchial tissue with acute inflammation and fibrosis, and granulomas with coagulation necrosis with organisms within morphologically consistent with Pneumocystis jiroveci noted on Gomori methenamine silver (GMS) stain by direct microscopy, and negative Acid-Fast Bacilli stain, (Fig. 2).