Abstract
Background: A review was undertaken of the clinical features and results of diagnostic tests in non-HIV infected patients who developed granulomatous Pneumocystis carinii pneumonia (PCP).
Methods: A retrospective review was performed of the charts and radiographs of patients with a granulomatous reaction to P carinii identified from computerised pathology records at Memorial Sloan Kettering Cancer Center, a university affiliated tertiary care hospital.
Results: Three cases were identified; the incidence of granulomatous PCP was 3%. All patients had risk factors for PCP and had received high dose corticosteroids which had been stopped. Two patients had received chemotherapy. Presentation was insidious with only mild symptoms; only one patient had fever. Chest radiographs showed a reticulonodular pattern. Bronchoscopy was negative for PCP in all cases and open lung biopsy was necessary.
Conclusion: A granulomatous pathological reaction to PCP occurs rarely in patients with malignancy. In these cases the clinical presentation may be atypical and bronchoscopy can be non-diagnostic.
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Selected References
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- Bozzette S. A., Sattler F. R., Chiu J., Wu A. W., Gluckstein D., Kemper C., Bartok A., Niosi J., Abramson I., Coffman J. A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. California Collaborative Treatment Group. N Engl J Med. 1990 Nov 22;323(21):1451–1457. doi: 10.1056/NEJM199011223232104. [DOI] [PubMed] [Google Scholar]
- Kester K. E., Byrd J. C., Rearden T. P., Zacher L. L., Cragun W. H., Hargis J. B. Granulomatous Pneumocystis carinii pneumonia in patients with low-grade lymphoid malignancies: a diagnostic dilemma. Clin Infect Dis. 1996 Jun;22(6):1111–1112. doi: 10.1093/clinids/22.6.1111. [DOI] [PubMed] [Google Scholar]
- Limper A. H., Offord K. P., Smith T. F., Martin W. J., 2nd Pneumocystis carinii pneumonia. Differences in lung parasite number and inflammation in patients with and without AIDS. Am Rev Respir Dis. 1989 Nov;140(5):1204–1209. doi: 10.1164/ajrccm/140.5.1204. [DOI] [PubMed] [Google Scholar]
- Russian D. A., Levine S. J. Pneumocystis carinii pneumonia in patients without HIV infection. Am J Med Sci. 2001 Jan;321(1):56–65. doi: 10.1097/00000441-200101000-00009. [DOI] [PubMed] [Google Scholar]
- Sarkar S., Dubé M. P., Jones B. E., Sattler F. R. Pneumocystis carinii pneumonia masquerading as tuberculosis. Arch Intern Med. 1997 Feb 10;157(3):351–355. [PubMed] [Google Scholar]
- Sepkowitz K. A., Brown A. E., Telzak E. E., Gottlieb S., Armstrong D. Pneumocystis carinii pneumonia among patients without AIDS at a cancer hospital. JAMA. 1992 Feb 12;267(6):832–837. [PubMed] [Google Scholar]
- Thomas C. F., Jr, Limper A. H. Pneumocystis pneumonia: clinical presentation and diagnosis in patients with and without acquired immune deficiency syndrome. Semin Respir Infect. 1998 Dec;13(4):289–295. [PubMed] [Google Scholar]
- Weber W. R., Askin F. B., Dehner L. P. Lung biopsy in Pneumocystis carinii pneumonia: a histopathologic study of typical and atypical features. Am J Clin Pathol. 1977 Jan;67(1):11–19. doi: 10.1093/ajcp/67.1.11. [DOI] [PubMed] [Google Scholar]
- Zaman M. K., White D. A. Serum lactate dehydrogenase levels and Pneumocystis carinii pneumonia. Diagnostic and prognostic significance. Am Rev Respir Dis. 1988 Apr;137(4):796–800. doi: 10.1164/ajrccm/137.4.796. [DOI] [PubMed] [Google Scholar]