IDCases | 2019
Pneumonia with normal computed tomography of the chest: An atypical presentation of Pneumocystis
Abstract
A 34-year-old woman presented with productive cough for two months, associated with subjective fevers and dyspnea on exertion. Work up included screening for HIV, which eventually confirmed a new diagnosis of AIDS, finding CD4 cells of 6% and 69 cells per mm. Subsequent imaging and sputum testing found negative results for all the following tests: CXR, nasopharyngeal respiratory viral multiplex polymerase chain reaction, routine sputum culture, and conventional CT chest (Fig. 1A and B). A sputum sample was sent for Pneumocystis jirovecii direct fluorescent antibody (DFA) staining, which found several applegreen fluorescent cysts (Fig. 2). Patient was started on two tabs of sulfamethoxazole-trimethoprim (800-160-mg orally every eight hours) without steroids. All respiratory symptoms resolved within two weeks of treatment, and patient completed a three week course. Antiretroviral therapy was started one day after pneumocystis pneumonia diagnosis, and the patient is clinically doing well on one month follow up. PJP is one of the most common pulmonary infections affecting patients with AIDS. Diagnosis of PJP often requires visualization of Pneumocystis jirovecii in tissue, bronchoalveolar lavage fluid, or sputum sample. Using DFA staining on sputum samples will confirm a diagnosis of PJP [1], but testing sensitivity ranges from around 50% for expectorated sputum to about 90% for induced