CTICasesInvasive Aspergillosis with Concurrent Pneumocystis jirovecii Pneumonia
Imaging findings
CT in a 29-year-old patient with newly diagnosed HIV (CD4 < 10) and spontaneous pneumothorax demonstrates a right lower lobe cavitary lesion and a large subcarinal conglomerate lymph node. Follow-up CT shows worsening bilateral ground-glass opacity. BAL galactomannan and beta-D-glucan were positive for Aspergillus; BAL PCR confirmed concurrent Pneumocystis jirovecii (PCP).
Key takeaways
Profoundly immunocompromised HIV patients with very low CD4 counts are at risk for multiple simultaneous opportunistic infections. Invasive aspergillosis (cavitary nodule, galactomannan-positive) and PCP (bilateral ground-glass opacity, beta-D-glucan positive) can coexist in the same patient. Cavitary lesions with subcarinal granulomatous lymphadenopathy in this context should prompt workup for both fungal and opportunistic pneumonia.
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