Pneumocystis Carinii Pneumonia

A 25-year-old man, who was an injection drug user, presented with a several-day history of dyspnea and fever. He complained of excessive malaise, fatigue, and weight loss but denied any hemoptysis. The examination of the lung revealed bilateral crackles in both lower zones. The chest film, pictured here, demonstrated bilateral symmetric interstitial and alveolar infiltrates. Bronchoscopy results confirmed the presence of Pneumocystis carinii pneumonia. The patient was seropositive for HIV.

Drs Sonia Arunabh and Navin Verma of Queens, NY, comment that the diagnosis of P carinii pneumonia can be elusive because it may be the first presentation of AIDS. They emphasize that all patients who have bilateral pneumonia, particularly subacute disease, need to be questioned for AIDS risk factors. If risk factors are present, consider P carinii in the differential. Findings that suggest the diagnosis are compatible radiographs, leukopenia and lymphopenia, elevated serum lactate dehydrogenase levels, oral candidiasis, and a widened alveolar-arterial oxygen tension difference.

This patient was given trimethoprim-sulfamethoxazole, and his condition slowly improved. He was discharged from the hospital and is being followed up at an outpatient clinic.