Bilateral upper-lobe cavitary Pneumocystis carinii pneumonia in a patient on dapsone prophylaxis.
Pneumocystis carinii pneumonia (PCP) presenting as bilateral upper-lobe cavitary disease is rare. Isolated upper-lobe involvement has traditionally been associated with aerosolized pentamidine prophylaxis. Dapsone is a cheap and effective prophylactic agent against P carinii in patients who cannot tolerate trimethoprim-sulfamethoxazole. This is a case of a man who presented with bilateral upper-lobe cavitary P carinii pneumonia despite being on dapsone prophylaxis. Bronchoalveolar lavage was negative for P carinii. Transbronchial biopsy was positive for P carinii. The patient improved significantly with radiological resolution on specific treatment for P carinii. PCP should be included in the differential diagnosis of upper-lobe cavitary lung disease, and a transbronchial biopsy should be performed when the diagnosis is suspected.
Department of Medicine, New York Methodist Hospital, Brooklyn, USA.
D A
DA
Jawahar
S
S
Dama
R
R
Miarrostami
H
H
Sadagdhar
N
N
Anandarao
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging* / Q000517:prevention & control; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003622:Dapsone / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000000981:diagnostic imaging* / Q000517:prevention & control; D011859:Radiography
D000890:Anti-Infective Agents; D003622:Dapsone