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1、BenGewurzGillianLieberman,MDAugust2002CysticPneumocystisPneumoniaBenGewurz,HarvardMedicalSchoolYearIVGillianLieberman,MDBenGewurzGillianLieberman,MDPatientPresentation•43y.o.malewithAIDSpresentswith1-monthh/ofatigue,non-productivecough,dyspnea;hemoptysisonthedayofadmiss
2、ion.–LastCD4=9cells/mm3.Viralload=67,000–OffHIVmedsx1month–OffPCPprophylaxis(pentamidine)x2months2BenGewurzGillianLieberman,MDPMH•HIV+since1993•PCPx2•Oralthrush•Toxoplasmosis(1995)•PneumococcalSepsis•HepB+,HepC+Socialhistory:•40pack-yearsmokinghistory•NoIVDA3BenGewurzGi
3、llianLieberman,MDRequisitionfromPrimaryCarePhysician•Physicalexamfindings:–DecreasedbreathsoundsatLbase–RalesonLside•PleaseobtainCXRtoR/Opulmonaryprocess4BenGewurzGillianLieberman,MDPatientInitialPresentationConsolidationMultipleAir-bronchogramcysticlesions56/20/02Court
4、esyofJamesBusch,M.D.andMattSpencer,M.D.BenGewurzGillianLieberman,MDPatientInitialPresentationConfluentAreaofOpacityCyst6/20/026CourtesyofJamesBusch,M.D.andMattSpencer,M.D.BenGewurzGillianLieberman,MDComparisonwithPriorStudyBIDMCPACSBIDMCPACS8/15/006/20/027BenGewurzGilli
5、anLieberman,MDHelicalCTonPresentationCystsVariableNodulesize,wallthickness(2-7mm)BIDMCPACS6/21/02NoContrast8BenGewurzGillianLieberman,MDHelicalCTonPresentationPatchyground-glassopacityCysticlesionCavitarynoduleBIDMCPACS9BenGewurzGillianLieberman,MDDifferentialDiagnosisf
6、orOurPatientIncludes:•AtypicalPneumocystispneumonia•Mycobacterialpneumonia•Fungalpneumonia•Cryptococcus,aspergillosis•Malignancy–KHSV,lymphoma•Bacterialpneumonia•Multiorganisminfection10BenGewurzGillianLieberman,MDDiagnosis•Patientwasadmittedforfurtherworkupandtreatment
7、ofsuspectedpulmonaryinfection.–Allcultureswerenegative–Threeinduced-sputumsallnegativeforPCP,AFB•Nonetheless,givenclinicalandradiologicalsuspicion,cysticPCPisthemost-likelydiagnosis•Empirictreatmentwasinitiated•IVpentamidine4mg/kg/dayx21days•Followclinicalandradiologica
8、lresponsetotherapy11BenGewurzGillianLieberman,MDSubsequentStudyDemonstratesImprovementBIDMCPACSBIDMCPACS6/20/0
