CTICasesBacillus cereus Pneumonia in a Stem Cell Transplant Recipient
Imaging findings
A very subtle right upper lobe abnormality appears on serial radiographs over roughly a month, absent on the earlier study. CT shows dense consolidation with air bronchograms at its edge but none in the centre, surrounded by ground glass that layers within individual lobules, producing an intralobular gradient. An accompanying pleural effusion is present.
Key takeaways
Bacillus cereus is a rare cause of pneumonia but does occur in immunocompromised patients, including stem cell transplant recipients. The findings here overlapped substantially with invasive fungal disease: absent central air bronchograms is a useful fungal sign, and surrounding ground glass has been described as haemorrhage since the invasive aspergillosis literature of the 1980s. An intralobular gradient — ground glass layering within a lobule and following gravity — suggests the ground glass is liquid, haemorrhage or oedema, rather than part of the mass itself. Aspergillus, Nocardia, and Legionella were all reasonable considerations before bronchoscopy.
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