Comparison of clinical and radiological features of pneumocystis pneumonia between malignancy cases and acquired immunodeficiency syndrome cases: a multicenter study.
BACKGROUND
The clinical features of pneumocystis pneumonia (PCP) differ according to the predisposing factors responsible for immunosuppression. Although PCP in patients with acquired immunodeficiency syndrome (AIDS) has been extensively described, its characteristics in non-AIDS patients, such as those with malignancies, are not thoroughly documented.


OBJECTIVE
To characterize and compare the clinical and imaging features of PCP in patients with malignancies with those in AIDS patients.


METHODS
A multi-center retrospective study.


METHODS
We evaluated the clinical and radiological features of PCP in 21 patients with malignancies and in 17 with AIDS. Clinical presentation, serum markers, oxygenation, CT findings, and outcome were examined.


RESULTS
The patients with malignancies showed shorter durations of symptoms before PCP was diagnosed. The levels of serum markers and the oxygenation index did not differ. CT showed diffuse or widespread ground-glass opacity (GGO) in all of the patients evaluated. None of the AIDS patients demonstrated consolidation, whereas half of the patients with malignancy showed consolidation along with GGO. The extent of GGO scored on CT images was significantly greater in the AIDS patients. No correlation was observed between the CT findings and other clinical parameters. All of the AIDS patients recovered from PCP, whereas six patients with malignancies died within a month after the onset of PCP.


CONCLUSIONS
The characteristics of the CT images differed between the patient groups with different underlying disorders, although it remains to be determined whether CT findings are associated with other clinical features or are predictive of the outcome of PCP.
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo. tasaka@cpnet.med.keio.ac.jp
Sadatomo
S
Tasaka
Hitoshi
H
Tokuda
Fumikazu
F
Sakai
Takeshi
T
Fujii
Kazuhiro
K
Tateda
Takeshi
T
Johkoh
Norio
N
Ohmagari
Hiromitsu
H
Ohta
Hideki
H
Araoka
Yoshimi
Y
Kikuchi
Masahide
M
Yasui
Kanako
K
Inuzuka
Hajime
H
Goto
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010100:Oxygen / Q000097:blood; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000890:Anti-Infective Agents; D015415:Biomarkers; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D010100:Oxygen