PMC9238193_01
A 73-year-old immunocompromised male patient with multiple myeloma with granulomatous Pneumocystis jiroveci pneumonia.. A. Initial axial chest CT image on admission shows widespread ground-glass opacities in both lungs.. B, C. Axial CT images of the mid (B) and lower thorax (C) show multiple subpleural nodules (arrowheads) in both lower lungs in addition to areas of ground-glass opacities.. D, E. Follow-up axial contrast-enhanced CT images obtained 10 days after the initial CT scan show disappearance of previously noted ground glass opacities in both lungs (D) but persistent subpleural nodules (arrowheads) with low attenuation (E).. F. Histopathologic image of the core specimen (1st) obtained from percutaneous CT-guided transthoracic needle biopsy demonstrates necrotic granulomas containing multiple colonies of micro-organisms (arrowheads) (Periodic acid-Schiff stain, x 40). On hematoxylin and eosin staining (2nd), multiple round or ovoid cysts with central dot-like structures are seen (arrowheads) (x 400). On Gomori methenamine silver staining (3rd), multiple round or crescent-shaped yeast-form micro-organisms are seen (arrowheads) (x 400), which were confirmed to be Pneumocystis jiroveci on immunohistochemistry (4th) (x 40).
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F1
A non-contrast high-resolution CT revealed a mosaic pattern of multifocal ground-glass opacities in both upper and mid lungs (Fig. 1A). In addition to it, there were also noted multiple subpleural nodules (size 1-3 cm in diameter) in both lower lungs (Fig. 1B, C). Follow-up contrast-enhanced chest CT taken in 10 days after the initial CT scan showed disappearance of multifocal ground-glass opacities (Fig. 1D) but persistent existence of multiple subpleural nodules without any change in size and extent. These nodules showed homogenous low attenuation showing an average of 40 Hounsfield unit (HU) on post-contrast CT with 20 HU net contrast enhancement (Fig. 1E). Percutaneous CT-guided transthoracic needle biopsy was done and the core biopsy specimen showed well-formed necrotic granulomas containing Pneumocystis jiroveci micro-organisms (Fig. 1F).