Summary
Atypical pulmonary manifestations of Pneumocystis carinii infection and fair numbers of extrapulmonary and disseminated infections have lately been documented in patients with human immunodeficiency virus infection treated prophylactically with inhalative pentamidine. We report the case of a 32-year-old homosexual patient who was assessed for complaints of night sweats, weight loss, and progressive malaise. The patient denied any respiratory tract symptoms such as cough, sputum production, pleuritic chest pain, or shortness of breath. Chest X-ray revealed two large round noncavitating lesions in the lower lobe of the right lung. Pneumocystomas were diagnosed by fine-needle aspiration. A 3-week course of intravenous high-dose cotrimoxazole resulted in amelioration of symptoms but no change in the radiographic appearance of the pulmonary lesions. Four months later the patient is alive and stable and is being treated with pentamidine inhalation of 300 mg per 2 weeks and two tablets of pyrimethamine sulfadoxine per week.
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Abbreviations
- PcP:
-
Pneumocystis carinii pneumonia
- Pc:
-
Pneumocystis carinii
- AIDS:
-
acquired immunodeficiency syndrome
- HIV:
-
human immunodeficiency virus
References
Amin MB, Abrash MP, Mezger E, Sekerak GF (1990) Systemic dissemination of Pc in a patient with acquired immune deficiency syndrome: Henry Ford Hosp Med J 38:68–71
Barrio JL, Suarez M, Rodriguez JL, Saldana MJ, Pitchenik AE (1986) PcP presenting as cavitating or noncavitating pulmonary nodules in patients with the AIDS. Am Rev Respir Dis 134:1094–1096
Bier S, Krivisky B, Leonidas J (1986) PcP presenting as a single pulmonary nodule. Pediatr Radiol 16:59–60
Bleiweiss IJ, Jagirdar JS, Klein MJ, Siegel JL, Krellenstein DJ, Gribetz AR, Strauchen JA (1988) Granulomatous PcP in three patients with the AIDS. Chest 94:580–584
Carbon C (1990) PcP in HIV-positive patients: incidence and clinical aspects. JAMA 6 [Suppl]:18–21
Chaffey MH, Klein JS, Gamsu G, Blanc P, Golden JA (1990) Radiographic distribution of PcP in patients with AIDS treated with prophylactic inhaled pentamidine. Radiology 175:715–719
Cross AS, Steibigel RT (1974) Pcp presenting as localized nodular densities. N Engl J Med 291:831–832
DeLorenzo LJ, Huang CT, Maguire GP, Stone DJ (1987) Roentgenographic patterns of PcP in 104 patients with AIDS. Chest 91:323–327
Ewig S, Niese D (1991) Atypische Formen der AIDS-assoziierten Pc-Infection. Dtsch Med Wochenschr 116:346–351
Girard P-M, Landman R, Gaudebout C, Lepretre A, Lottin P, Michon C, De Truchis P, Matheron S, Camus F, Farinotti R, Marche C, Coulaud J-P, Saimot AD (1989) Prevention of PcP relapse by pentamidine aerosol in zidovudine-treated AIDS patients. Lancet I:1348–1353
Centers for Disease Control (1989) Guidelines for prophylaxis against PcP for persons infected with HIV. MMWR 38 [Suppl 5]:1–9
Hartz JW, Geisinger KR, Scharyi M, Muss HB (1985) Granulomatous pneumocystosis presenting as a solitary pulmonary nodule. Arch Pathol Lab Med 109:466–469
Hirschel B, Lazzarin A, Chopard P, Opravil M, Furrer HJ, Rüttimann S, Vernazza P, Chave JP, Ancarani F, Gabriel V, Heald A, King R, Malinverni R, Martin JL, Mermillod B, Nicod L, Simoni L, Vivirito MC, Zerboni R (1991) A controlled study of inhaled pentamidine for primary prevention of PcP. N Engl J Med 324:1079–1083
Jules-Elysee KM, Stover DE, Zaman MB, Bernard EM, White DA (1990) Aerosolized pentamidine: effect on diagnosis and presentation of PcP. Ann Intern Med 112:750–757
Kovacs JA, Masur H (1988) PcP: therapy and prophylaxis. J Infect Dis 158:254–258
Leoung GS, Feigal DW Jr, Montgomery AB, Corkery K, Wardlaw L, Adams M, Busch D, Gordon S, Jacobson MA, Volberding PA, Abrams D (1990) Aerosolized pentamidine for prophylaxis against PcP. N Engl J Med 323:769–775
Northfelt DW, Clement MJ, Safrin S (1990) Extrapulmonary pneumocystosis: clinical features in human immunodeficiency virus infection. Medicine 69:392–393
Tezlak EE, Cote RJ, Gold JWM, Campbell SW, Armstrong D (1990) Extrapulmonary Pc infections. Rev Infect Dis 12:380–386
Unger PD, Rosenblum M, Krown SE (1988) Disseminated Pc infection in a patient with acquired immune deficiency syndrome. Hum Pathol 19:113–116
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Albrecht, H., Stellbrink, HJ., Fenske, S. et al. A novel variety of atypical pneumocystis carinii infection after long-term prophylactic pentamidine inhalation in an AIDS patient: large lower lobe pneumocystoma. Clin Investig 71, 310–313 (1993). https://doi.org/10.1007/BF00184733
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DOI: https://doi.org/10.1007/BF00184733