PMC7303748_01
Cross-sectional computerized scan of the chest revealing nodular opacities and ground glass opacities (GGOs) with cavitation in lung field.
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A CT of the chest was done as a part of workup revealed moderate right and small left pleural effusions, consolidation in the dependent lung bases, nodular opacities in both lungs, some cavitary in nature, and patchy ground glass opacity in both lungs (Figure 1).
Cross-sectional and coronal computerized tomogram of abdomen with intravenous contrast revealing a hypodense lesion of 6.7 cm in the cephalad aspect of the spleen with adjacent small nodule, multiple liver lesion, and ascites.
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CT abdomen and pelvis done for chronic diarrhea and abdominal pain revealed a hypodense lesion within the cephalad aspect of the spleen, a 6.7 cm splenic mass with adjacent small nodule, multiple hypodense hepatic lesions, measuring up to 12 mm in diameter, and mild ascites in the upper abdomen (Figure 2).
Magnetic resonance imaging of abdomen with gadolinium revealing a heterogeneous lesion in upper pole of the spleen measuring approximately 5.2 x 4.3 cm in size.
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Magnetic resonance imaging (MRI) abdomen showed a heterogeneous lesion within the upper pole of the spleen measuring 5.2 x 4.3 cm in size with absent enhancement centrally, with some enhancement along the peripheral aspect of the lesion, suggesting central necrosis (Figure 3).
Splenic biopsy with Pneumocystis jirovecii infection showing necrotizing granulomatous inflammation/frothy exudate (hematoxylin and eosin stain, magnification x100 low power).
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The histopathology revealed necrotizing granulomas on hematoxylin and eosin stain (Figures 4 and 5) with Pneumocystis jirovecii infection on Grocott-Gomori's methenamine silver (GMS) stain (Figures 6(a) and 6(b)).
Splenic biopsy with Pneumocystis jirovecii infection showing necrotizing granuloma and frothy exudate surrounded by epitheloid cells (hematoxylin and eosin, magnification x400).
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The histopathology revealed necrotizing granulomas on hematoxylin and eosin stain (Figures 4 and 5) with Pneumocystis jirovecii infection on Grocott-Gomori's methenamine silver (GMS) stain (Figures 6(a) and 6(b)).
Splenic biopsy on Grocott-Gomori methenamine silver (GMS) stain with 400 times magnification showing the necrotic and frothy infiltrate containing multiple Pneumocystis jirovecii organisms (arrow indicates P. jirovecii).
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The histopathology revealed necrotizing granulomas on hematoxylin and eosin stain (Figures 4 and 5) with Pneumocystis jirovecii infection on Grocott-Gomori's methenamine silver (GMS) stain (Figures 6(a) and 6(b)).