CTICasesPneumocystis jirovecii Pneumonia (PJP) with Diffuse Alveolar Damage in a Post-Transplant Patient
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Imaging findings
Serial radiographs and CT scans demonstrate progressive, upper-lobe predominant, bronchocentric ground-glass nodules and consolidation that rapidly evolved into diffuse, dense consolidation with air bronchograms, architectural distortion, traction bronchiectasis, and the formation of small pulmonary cysts. The patient required venovenous extracorporeal membrane oxygenation (ECMO). Autopsy confirmed diffuse alveolar damage (DAD) and alveoli completely filled with Pneumocystis jirovecii.
Key takeaways
Pneumocystis jirovecii pneumonia (PJP) in non-HIV, immunosuppressed patients (such as those undergoing chemotherapy or post-transplant) often presents more acutely and with more severe inflammatory injury than in HIV patients. This can precipitate severe diffuse alveolar damage, rapidly progressing to respiratory failure requiring ECMO, making early recognition and adherence to PJP prophylaxis critical.
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