Unmasking Granulomatous Pneumocystis jirovecii Pneumonia with Nodular Opacity in an HIV-Infected Patient after Initiation of Antiretroviral Therapy
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Pneumocystis jirovecii pneumonia (PJP) in patients with HIV infection can, in rare cases, present with pulmonary nodules that histologicallyinvolve granulomatous inflammation. This report describes an intriguing case of granulomatous PJP with pulmonarynodules after commencing antiretroviral therapy (ART) in an HIV-infected patient without respiratory signs or symptoms. Diagnosisof granulomatous PJP was only achieved through thoracoscopic lung biopsy. This case suggests that granulomatous PJP shouldbe considered in the differential diagnosis of pulmonary nodules in HIV-infected patients for unmasking immune reconstitutioninflammatory syndrome manifestation after initiation of ART.
Abstract
Pneumocystis jirovecii pneumonia (PJP) in patients with HIV infection can, in rare cases, present with pulmonary nodules that histologicallyinvolve granulomatous inflammation. This report describes an intriguing case of granulomatous PJP with pulmonarynodules after commencing antiretroviral therapy (ART) in an HIV-infected patient without respiratory signs or symptoms. Diagnosisof granulomatous PJP was only achieved through thoracoscopic lung biopsy. This case suggests that granulomatous PJP shouldbe considered in the differential diagnosis of pulmonary nodules in HIV-infected patients for unmasking immune reconstitutioninflammatory syndrome manifestation after initiation of ART.
참고문헌 (16)
- Travis WD, "Atypical pathologic manifestations of Pneumocystis carinii pneumonia in the acquired immune deficiency syndrome. Review of 123 lung biopsies from 76 patients with emphasis on cysts, vascular invasion, vasculitis, and granulomas", Am J Surg Pathol, 14, pp.615~625 (1990)
- Hartel PH, "Granulomatous reaction to pneumocystis jirovecii: clinicopathologic review of 20 cases", Am J Surg Pathol, 34, pp.730~734 (2010)
- Totet A, "Pneumocystis jirovecii genotypes and granulomatous pneumocystosis", Med Mal Infect, 36, pp.229~231 (2006)
- Gilroy SA, "Pneumocystis pneumonia", Semin Respir Crit Care Med, 32, pp.775~782 (2011)
- Autran B, "Positive effects of combined antiretroviral therapy on CD4+ T cell homeostasis and function in advanced HIV disease", Science, 277, pp.112~116 (1997)
- Blumenfeld W, "Granulomatous pulmonary lesions in patients with the acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii infection", Ann Intern Med, 109, pp.505~507 (1988)
- Klein JS, "Cavitating and noncavitating granulomas in AIDS patients with Pneumocystis pneumonitis", AJR Am J Roentgenol, 152, pp.753~754 (1989)
- Birley HD, "Granulomatous Pneumocystis carinii pneumonia in a patient with the acquired immunodeficiency syndrome", Thorax, 45, pp.769~771 (1990)
- Flannery MT, "Pneumocystis carinii pneumonia with an atypical granulomatous response", South Med J, 89, pp.409~410 (1996)
- Takahashi T, "Reconstitution of immune responses to Pneumocystis carinii pneumonia in patients with HIV infection who receive highly active antiretroviral therapy", Res Commun Mol Pathol Pharmacol, 112, pp.59~67 (2002)
- Chen F, "Concurrent granulomatous Pneumocystis carinii and Mycobacterium xenopi pneumonia:an unusual manifestation of HIV immune reconstitution disease", Thorax, 59, pp.997~999 (2004)
- Sabur N, "Granulomatous Pneumocystis jiroveci pneumonia associated with immune reconstituted HIV", Can Respir J, 18, pp.e86~e88 (2011)
- Wu AK, "The unmasking of Pneumocystis jiroveci pneumonia during reversal of immunosuppression: case reports and literature review", BMC Infect Dis, 4, pp.57~ (2004)
- Müller M, "Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis", Lancet Infect Dis, 10, pp.251~261 (2010)
- Calderón EJ, "Pneumocystis infection in humans: diagnosis and treatment", Expert Rev Anti Infect Ther, 8, pp.683~701 (2010)
- Lundberg BE, "Epidemiology of Pneumocystis carinii pneumonia in an era of effective prophylaxis: the relative contribution of non-adherence and drug failure", AIDS, 14, pp.2559~2566 (2000)