title: Pneumocystis Pneumonia Presenting as an Enlarging Solitary Pulmonary Nodule.
abstract: Pneumocystis pneumonia is a life threatening infection that usually presents with diffuse bilateral ground-glass infiltrates in immunocompromised patients. We report a case of a single nodular granulomatous Pneumocystis pneumonia in a male with diffuse large B-cell lymphoma after R-CHOP therapy. He presented with symptoms of productive cough, dyspnea, and right-sided pleuritic chest pain that failed to resolve despite treatment with multiple antibiotics. Chest X-ray revealed right lower lobe atelectasis and CT of chest showed development of 2 cm nodular opacity with ground-glass opacities. Patient underwent bronchoscopy and biopsy that revealed granulomatous inflammation in a background of organizing pneumonia pattern with negative cultures. Respiratory symptoms resolved but the solitary nodular opacity increased in size prompting a surgical wedge resection which revealed granulomatous Pneumocystis pneumonia infection. This case is the third documented report of Pneumocystis pneumonia infection within a solitary pulmonary nodule in an individual with hematologic neoplasm. Although Pneumocystis pneumonia most commonly occurs in patients with HIV/acquired immunodeficiency syndrome and with diffuse infiltrates, the diagnosis should not be overlooked when only a solitary nodule is present.
authors.affiliation: Department of Pulmonary & Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Krunal Bharat
authors.identifier: 0000-0003-0638-938X
authors.initials: KB
authors.lastname: Patel
authors.affiliation: Department of Pulmonary & Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: James Benjamin
authors.identifier: 0000-0002-5750-3552
authors.initials: JB
authors.lastname: Gleason
authors.affiliation: Department of Pathology, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Maria Julia
authors.initials: MJ
authors.lastname: Diacovo
authors.affiliation: Department of Pulmonary & Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: Nydia
authors.initials: N
authors.lastname: Martinez-Galvez