PMC9097713_01
Imaging findings on admission. (A) Chest radiograph taken upon admission reveals bilateral central consolidation. (B, C) Chest computed tomography images reveal bilateral central consolidation with peripheral sparing, accompanied by cysts and traction bronchiectasis.
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A chest radiograph revealed bilateral central consolidation (Fig. 1A). Chest computed tomography (CT) revealed bilateral central consolidation with peripheral sparing, some accompanied by cysts and traction bronchiectasis (Fig. 1B and C).
Pathological images of transbronchial lung biopsy (TBLB) specimens. (A) A TBLB specimen of the right upper and lower lobe shows highly granulomatous inflammation infiltrated with inflammatory cells, mainly macrophages, obscuring the alveolar structure ( x 200, hematoxylin-eosin staining). (B) Accumulation of periodic acid-Schiff-positive foamy eosinophilic material in the alveolar spaces of the TBLB specimen ( x 400, periodic acid-Schiff staining). (C) A large number of cysts suspected to be Pneumocystis jirovecii are visible within the foamy exudate of the TBLB specimen ( x 400, Grocott methenamine silver (GMS) stain).
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Furthermore, in the alveolar spaces, accumulation of periodic acid-Schiff-positive foamy eosinophilic materials was observed, while Grocott methenamine silver (GMS) stain revealed cystic forms of P. jirovecii (Fig. 2A-C).
Chest radiographs taken during and after the course of treatment. Chest radiographs obtained (A) on admission; (B) a week following the administration of trimethoprim and sulfamethoxazole; (C) at the end of the treatment; and (D) 5 weeks following treatment completion.
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The patient's symptoms and chest radiograph findings improved with treatment (Fig. 3).