A 38-Year-Old Woman With Progressive Shortness of Breath

A 38-year-old woman presented with dyspnea and fever of 15 days’ duration accompanied by dysphagia and loss of weight. Clinical examination revealed tachypnea and bibasilar fine crepitations. Blood gases showed hypoxemia. Chest radiography showed hazy increased lung opacity and coarse lung markings symmetrically involving the lung bases. High-resolution computed tomography of the lung showed patchy subpleural foci of ground glass attenuation bilaterally in the upper lobes. In the lower lobes, there was evidence of peripheral peribronchial bibasilar consolidation, which was more extensive on the left side and associated with marked subpleural sparing on the right side. Human immunodeficiency viral enzyme linked immunosorbent assay testing was positive. Bronchoscopic transbronchial lung biopsy revealed alveoli distended with foamy acellular eosinophilic material. Gomorimethanamine silver stain was positive for organisms, distributed throughout the alveolar spaces. A diagnosis of Pneumocystis jirovecii pneumonia was made and she was treated for the same and improved. Here, we present a case of P. jirovecii pneumonia with atypical imaging features.

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