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Case Reports in Infectious Diseases
Volume 2016, Article ID 1873237, 4 pages
http://dx.doi.org/10.1155/2016/1873237
Case Report

Pneumocystis Pneumonia Presenting as an Enlarging Solitary Pulmonary Nodule

1Department of Pulmonary & Critical Care Medicine, Cleveland Clinic Florida, Weston, FL, USA
2Department of Pathology, Cleveland Clinic Florida, Weston, FL, USA

Received 27 June 2016; Revised 3 August 2016; Accepted 14 August 2016

Academic Editor: Sinésio Talhari

Copyright © 2016 Krunal Bharat Patel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.