PMC10009051_01
(A): Chest x-ray on Day 1 revealed multiple lung cysts. (B): Chest CT on Day 1 revealed multiple, diffuse lung cysts.
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A chest x-ray and Chest computed tomography (CT) revealed multiple lung cysts, respectively (Fig. 1 (A), (B)). Chest CT on Day 24 revealed a decrease in the number of lung cysts (Fig. 1. (H)). Abdominal contrasted CT performed on the same day revealed enlargement of the multiple cystic lesions in the spleen (Fig. 1. (I), (J)).
(A), (B): Abdominal contrast CT on Day 1 revealed multiple, hypodense, cystic lesions in the spleen.
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In addition, abdominal contrasted CT revealed multiple hypodense cystic lesions in the spleen (Fig. 2. (A), (B)).
(A): Hematoxylin-eosin staining of the spleen revealed infiltration of foamy macrophages. (B): Grocott's methenamine silver staining of the spleen revealed spherical cysts. (C): Immunofluorescence assay for P. jirovecii demonstrated the presence of P. jirovecii cysts.
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An ultrasound-guided needle biopsy of the spleen was performed on Day 4, and histological analysis revealed infiltration of foamy macrophages without granulomatous inflammation and lymphoid cells (Fig. 3 (A)). Auramine-rhodamine staining did not reveal any bacteria and acid-fast bacilli, respectively, Grocott's methenamine silver staining revealed spherical cysts compatible with P. jirovecii (Fig. 3. (B)). An immunofluorescence assay for P. jirovecii was also positive for the cysts (Fig. 3. (C)).
Chest CT on Day 24 revealed a decrease in the number of lung cysts.
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Based on these findings, an extrapulmonary P. jirovecii infection of the spleen was diagnosed.(Fig. 4, Fig. 5).