Tuberc Respir Dis.  2010 Feb;68(2):97-100. 10.4046/trd.2010.68.2.97.

A Case of Pneumocystis Pneumonia Mimicking Acute Eosinophilic Pneumonia in a Patient with AIDS

• Lee BR
• Kim HK
• Park IN
• Choi SB
• Jung H
• Lee HK
• Lee SS
• Lee YM
• Lee HP
• Choi SJ
• Yum HK

• KMID: 2050592
• DOI: http://doi.org/10.4046/trd.2010.68.2.97

Abstract

73-year-old man was admitted with a sudden onset of dyspnea. He had never smoked. The chest radiograph and computed tomography revealed bilateral ground glass opacity and an enlarging perihilar consolidation with lymphadenopathies. There was a higher percentage of eosinophils (72%) in the bronchoalveolar lavage fluid (BALF) than normal. The patient was diagnosed with acute eosinophilic pneumonia and managed with steroid. Pneumocystis pneumonia (PCP) was diagnosed by an examination of the BALF, and the patient was treated with trimethoprim-sulphamethoxazole. The patient tested positive to the HIV antibody and the peripheral blood CD-4 positive lymphocyte count was only 33/microliter. The percentage of eosinophils in the BALF can increase in some cases of PCP that is complicated with AIDS. Only a few cases of eosinophilic pneumonia associated with PCP pneumonia have been reported in patients with AIDS but there are no case reports in Korea. This case highlights the need to consider PCP when the percentage of eosinophils in the BALF is elevated.

Keyword

Pneumocystis; Eosinophils; Acquired Immunodeficiency Syndrome

MeSH Terms

Acquired Immunodeficiency Syndrome
Aged
Bronchoalveolar Lavage Fluid
Dyspnea
Eosinophils
Glass
HIV
Humans
Korea
Lymphocyte Count
Pneumocystis
Pneumonia
Pneumonia, Pneumocystis
Pulmonary Eosinophilia
Smoke
Thorax
Smoke

Figure

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  Figure 1 Chest PA at emergency room (A) and 14th hospital day (B). The bilateral hilar enlargement and ground glass opecities with increased interstitial markings were showed and improved 2 weeks later.

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  Figure 2 Chest computed tomography on admission. The bilateral perihilar ground glass opecities with increased interstitial markings were showed.

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  Figure 3 Bronchoalveolar lavage fluid. (A) The nucleus of eosinophils contains one to two lobes. The cytoplasm is abundant with a full complement of bright reddish specific granules (Giemsa stain, ×400). (B) Pneumocystis jirovecci aggregates of many discoid shaped cysts with thick, darkly stained, silver-positive capsule and a central tiny dot (GMS stain, ×400).

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