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Diffuse pulmonary infiltrates in an immunocompromised patient

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1 Diffuse pulmonary infiltrates in an immunocompromised patient
Binal S. Kancherla, MD, Megan K. Dishop, MD, Steven S. Rothenberg, MD, Leland L. Fan, MD  Journal of Allergy and Clinical Immunology  Volume 121, Issue 2, Pages (February 2008) DOI: /j.jaci Copyright © 2008 American Academy of Allergy, Asthma & Immunology Terms and Conditions

2 Fig 1 High-resolution computed tomography of the chest in this patient revealed diffuse reticulonodular opacities and patchy ground-glass opacities. Journal of Allergy and Clinical Immunology  , DOI: ( /j.jaci ) Copyright © 2008 American Academy of Allergy, Asthma & Immunology Terms and Conditions

3 Fig 2 A, Lung biopsy in this patient showed patchy areas of individual and confluent epithelioid granulomas. Most were small and nonnecrotizing, with scattered associated lymphocytes, multinucleate giant cells, and focal organizing pneumonia pattern (hematoxylin and eosin stain, ×10 magnification). B, Silver staining showed only a few Pneumocystis species organisms within the granulomas distributed individually and in small clusters, the largest of which is demonstrated here (methenamine silver nitrate stain, ×1000 magnification). Journal of Allergy and Clinical Immunology  , DOI: ( /j.jaci ) Copyright © 2008 American Academy of Allergy, Asthma & Immunology Terms and Conditions

4 Fig 3 A, This lung biopsy specimen from a patient undergoing lung transplantation demonstrates the “classic” pattern of PJP, including abundant “frothy” alveolar proteinaceous material (hematoxylin and eosin strain, ×100 magnification). The finely vacuolated appearance of the alveolar material is produced by negative contrast of the organism within the exudates. B, Diagnosis is confirmed by silver staining, which highlights abundant cup-shaped organisms, some of which show characteristic dot-like capsular thickening (methenamine silver nitrate stain, ×1000 magnification). Journal of Allergy and Clinical Immunology  , DOI: ( /j.jaci ) Copyright © 2008 American Academy of Allergy, Asthma & Immunology Terms and Conditions

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