PMC7301693_01
Clinical characteristics of our patient. Chest CT showed disclosed extensive progressive interstitial changes in both lungs on August 2016.
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F1
Computed tomography (CT) scan of the chest showed ground-glass density images in both lungs (Figure 1).
(A) The "milky" bronchoalveolar lavage fluid. (B)
P. jirovecii was detected in the bronchoalveolar lavage fluid by silver hexamine staining.
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F2
The bronchoalveolar lavage fluid appeared milky (Figure 2A), while hematoxylin-eosin staining showed extensive macrophage infiltration in the alveolar and bronchial cavities without evidence of fibrosis and hexamine-silver staining for bronchoalveolar lavage fluid revealed the presence of P. jirovecii (Figure 2B).
(A) Pathology showed large amounts of PAS-positive lipoproteins in alveolar and bronchial cavities (x100). (B) Pathology showed large amounts of D-PAS-positive fine granular lipoproteins in alveolar and bronchial cavities (x100).
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F3
Moreover, large amount of periodic acid-Schiff (PAS) stain-positive and diastase-Periodic acid-Schiff (D-PAS) stain-positive substance was found in the alveolar and bronchial cavities (Figures 3A,B), consistent with pathological characteristics of PAP and non-specific interstitial pneumonia.
PMC7301693_02
Chest CT showed significant improvement in both lungs on August 2018.
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F4
A chest CT showed significant improvement in both lungs in the latest follow-up (Figure 4).