CTICasesNon-HIV Pneumocystis Pneumonia from High-Dose Corticosteroids
Imaging findings
A 73-year-old woman with metastatic small cell lung cancer and brain metastases treated with whole-brain radiation and high-dose steroids develops cough with progressive bilateral upper-lobe-predominant nodular consolidation on radiographs that fails to improve with antibacterial treatment for presumed community-acquired pneumonia. CT shows predominantly ground-glass opacity with spared secondary pulmonary lobules and peribronchial/perilobular thickening, an organizing-pneumonia-like pattern.
Key takeaways
Upper-lobe-predominant ground-glass opacity that fails standard antibacterial therapy in a patient on high-dose corticosteroids -- even without HIV or hematologic malignancy -- should prompt testing for Pneumocystis, since high-dose steroids alone (here, dexamethasone for cerebral edema) are a sufficient and often under-recognized risk factor for PJP.
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