PMC5738569_01
Chest roentgenogram at referring hospital. AP chest radiograph at outside hospital performed 4 days prior. Diffuse micronodules greater in the right lung are seen. Hint of small cavities is noted (blue arrows).
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Chest radiograph at that time showed diffuse micronodules, greater in the right lung (Figure 1).
Chest roentgenogram on admission to our hospital. AP chest radiograph at presentation. Again seen are diffuse micronodules with confluent areas in the right upper and lower lungs. Hint of small cavities is again noted (blue arrows).
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Chest roentgenogram revealed diffuse micronodules with confluent areas of nodular opacities (Figure 2).
Selected images of computed tomography (CT) scan of the chest on admission to our hospital. Axial images in lung window confirm diffuse micronodules with central cavitation of varying sizes (blue arrows).
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A noncontrast, volumetric chest CT scan (Figure 3) revealed diffuse micronodules with central cavitation and bronchial wall thickening, most suspicious for mycobacterial or fungal infection.
Transbronchial biopsy pathologic results. Pathologic evidence for PCP infection from the patient's transbronchial biopsy specimen. (a) Hematoxylin and eosin- (H&E-) stained section demonstrates classic intra-alveolar eosinophilic foamy exudates. (b) Gomori methenamine silver (GMS) special stain demonstrates nonbudding cysts with thin walls and intracystic capsular dots, consistent with Pneumocystis jirovecii-type fungal organisms.
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Pathologic analysis of the transbronchial biopsy specimen demonstrated foamy exudates on hematoxylin and eosin- (H&E-) stained sections, and silver stain revealed Pneumocystis jirovecii-type fungal organisms confirming the diagnosis to be PCP (Figure 4).
Chest roentgenogram four months after hospitalization. (a) PA and (b) lateral chest radiographs post treatment four months later demonstrated marked improvements.
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He was discharged home on hospital day 10 without requiring supplemental oxygen and did well thereafter, with a resolution of radiographic abnormalities on imaging obtained four months later (Figure 5).