CTICasesPneumocystis jirovecii Pneumonia (PJP) with Diffuse Alveolar Damage in an Undiagnosed HIV Patient
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Imaging findings
Initial chest radiograph was normal, but a follow-up radiograph three weeks later showed diffuse, coarse opacities with air bronchograms. Contrast-enhanced CT shows bilateral, segmental pulmonary emboli (an incidental red herring) and diffuse, bilateral ground-glass opacities with mild bronchial dilation and early organizing changes.
Key takeaways
PJP can be the initial presenting opportunistic infection in patients with undiagnosed HIV/AIDS. The classic imaging presentation is diffuse, symmetric ground-glass opacities without significant pleural effusion or septal thickening, which can quickly progress to diffuse alveolar damage and fatal respiratory failure if treatment with trimethoprim-sulfamethoxazole and corticosteroids is delayed.
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