Current Concepts in the Diagnosis and Management of Pneumocystis Pneumonia in Solid Organ Transplantation.

Pneumocystis jirovecii is an opportunistic fungus that is classically associated with pneumonia in immunocompromised patients, particularly those with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). However, this infection is now more commonly seen in those with malignancy, particularly lymphoproliferative disorders. Classic image findings with Pneumocystis jirovecii pneumonia (PJP) include bilateral ground-glass opacities with or without cyst formation. Up to 5% of patients with PJP may present with atypical image findings, specifically nodular opacities or masses thought to represent granulomatous inflammation. The differential diagnosis for a new solitary pulmonary nodule in an immunocompromised patient is broad. One must first rule out a recurrence of malignancy or new primary malignancy. In our patient's case, two nondiagnostic bronchoscopies with EBUS-TBNA eventually led to a surgical resection, which revealed a diagnosis of nodular necrotizing granulomatous Pneumocystis jirovecii. The diagnostic yield from EBUS is not well established, and most cases require surgical biopsy for definitive diagnosis. Further data regarding the use of EBUS-TBNA in diagnosing granulomatous PJP is needed.

/pdf/necrotizing-granulomatous-pneumocystis-infection-presenting-1dbz77to.pdf

Necrotizing Granulomatous Pneumocystis Infection Presenting as a Solitary Pulmonary Nodule: A Case Report and Review of the Literature

Late-onset Pneumocystis jirovecii pneumonia (PCP) can be developed in solid organ transplant (SOT) patients. Granulomatous P. jirovecii pneumonia (GPCP) can occur in immunocompromised patients, but has rarely been reported in SOT recipients. The diagnosis of GPCP is difficult since the sensitivity of sputum and bronchoalveolar lavage is low and atypical patterns are shown. A 60-year-old man, who had undergone renal transplantation 24 years ago presented with nodular and patchy lung lesions. He was asymptomatic and stable. After empirical treatment with a fluoroquinolone, the condition partially resolved but relapsed 4 months later. The pulmonary nodule was resected, and GPCP was confirmed. The pathogenesis of GPCP remains unclear, but in SOT recipients presenting with an atypical lung pattern, GPCP should be considered. This case was discussed at the Grand Clinical Ground of the Korean Society of Infectious Disease conference on November 3, 2022. 

Late-Onset Granulomatous Pneumocystis Jirovecii Pneumonia in A Renal Transplant Recipient: A Clinical Grand Round Conference Case in 2022

A 68-year-old male patient was diagnosed with Dukes stage B1 middle rectal cancer in April 2015. Some calcified tuberculomas were at right lung due to old pulmonary tuberculosis (PTb) for 10 years. Acute hepatitis B virus (HBV) flare up occurred just before rectal cancer surgery, and subsided after 1 month of entecavir. The entecavir treatment lasted for 1 year, and the liver enzymes were normal till now. He received a short-course preoperative radiotherapy in 2500 cGy/5 fractions, lower anterior resection, and postoperative adjuvant medications with oral tegafur 100 mg and uracil 224 mg for 6 months from June to November 2015. No recurrence occurred until February 2020, when a new solitary 1.1 cm spiculated nodule at right middle lobe of lung was noted in chest CT (Figure 1A). He reported no airway or infection symptoms. He underwent video-assisted thoracoscopic surgical biopsy directly in March 2020 since CT-guided biopsy is difficult for such a tiny nodule. The specimen grossly showed white to grayish nodules in cluster, approximately 1.8 × 0.8 cm

Granulomatous Pneumocystis jirovecii mimics pulmonary metastasis in rectal cancer.

Pneumocystosis is an opportunistic infection responsible for severe infiltrative pneumonia and death in immunocompromised patients. However, few studies have been carried out to identify the epidemiological aspects of this pneumonia in our context. Its frequency at Morocco in not well known Our work is a descriptive, analytical and retrospective study of 20 cases collected from January 2008 to December 2021 in the respiratory diseases department of the IBN ROCHD in Casablanca. The goal is to give a better characterization of the specificities of this pathology in our context and thus to contribute to better management. We identified 12 men and 8 women, aged 28 to 45 with an average age of 37. Dyspnea (100%), hyperthermia (90%) and dry cough (30%) were the symptoms indicative of the infection. Pneumocystis jirovecii was isolated from bronchial aspiration fluid in 5 cases. The diagnosis was therefore radio-clinical in 75% of the cases. The LDH level was increased in 18 patients with an average value of 1379.3 UI/l. Curative treatment with the Triméthoprim-Sulfaméthoxazole combination has been initiated in all our patients. Fifty-five percent of patients adjuvant corticosteroid therapy and only 50% were on oxygen therapy. Prophylaxis remains the best treatment for combating this scourge.

/pdf/pneumocystis-in-the-pulmonary-department-about-20-cases-12n6mcq8.pdf

Pneumocystis in the Pulmonary Department: About 20 Cases

High-resolution CT, histopathologic, and clinical features of granulomatous pneumocystis jiroveci pneumonia.

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High-resolution CT, histopathologic, and clinical features of granulomatous pneumocystis jiroveci pneumonia.