PMC5581851_01
CT chest showing diffuse bilateral ground glass opacities.
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Given the patient's hypoxia and demonstration of diffuse ground glass opacities on computed tomography (CT) of the chest [Fig. 1], a clinical diagnosis of PCP was made, and the patient was switched to intravenous (IV) trimethoprim-sulfamethoxazole (TMP-SMX) and corticosteroids.
CT chest 3 weeks later showing "crazy-paving pattern".
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A pap-stained cytology slide of the bronchioalveolar lavage showed enlarged cells with a large intranuclear inclusion which is surrounded by a halo, creating an "owl's eye" appearance characteristic of Cytomegalovirus (arrow, top). Alveolar casts which are consistent with pneumocystis (asterisk, bottom) are also seen. Papanicolaou stain, original magnification x500.
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Also present were alveolar casts which stained weakly with Gomori methenamine silver (GMS) and revealed structures morphologically consistent with Pneumocystis organisms [Fig. 3].