CTICasesNecrotizing Pneumonia (Group A Streptococcus) and Pneumocystis Pneumonia
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Imaging findings
Initial chest radiograph showed consolidation in the right upper lobe and left lower lobe with diffuse hazy opacities. High-resolution CT revealed a lobar pneumonia appearance with additional ground-glass opacities. Subsequent radiographs demonstrated a rapidly progressing left lower lobe lucency evolving into a conspicuous, huge cavity consistent with necrotizing pneumonia. Follow-up CT showed confluent ground-glass opacities in the upper lobes, while the right lower lobe showed clearance.
Key takeaways
This case illustrates the rapid progression of a severe pulmonary infection in an untreated HIV-positive patient. The patient had a co-infection of Group A Streptococcus, causing necrotizing pneumonia with rapid cavitation, and Pneumocystis Pneumonia (PJP). The case highlights the importance of recognizing the dynamic radiographic changes, including cavitation, and considering co-infections in immunocompromised individuals.
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