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Pneumocystis jirovecii pneumonia (PJP) with a geographic crazy paving pattern

Imaging findings

CT scan of a patient with undiagnosed HIV shows a striking geographic crazy paving pattern and ground-glass opacities, mimicking pulmonary alveolar proteinosis.

Key takeaways

PJP pneumonia classically presents with diffuse ground-glass opacities, but can manifest as a highly geographic crazy paving pattern. The presence of weight loss and lymphopenia should prompt HIV screening and PJP testing.

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