CHEST IMAGING: Immunocompromised

Case Author: Maria Shiau, MD, New York University School of Medicine, Langone Medical Center

History

25-year-old woman with fever and cough and positive HIV status.

Imaging Findings

Posteroanterior chest radiograph shows a cavitary lesion in the mid right lung.

Diagnosis

Pneumocystis jiroveci pneumonia

Teaching Points

Cavitary lung disease in patients with AIDS should be assumed infectious until proved to have a noninfectious cause and is frequently polymicrobial. Another etiologic factor is neoplasms.

Cavitary pneumonia is an atypical presentation of Pneumocystis pneumonia.

Presence of mediastinal or hilar lymphadenopathy is more common in patients with mycobacterial pathogens.

The mean CD4 count in patients with cavitary disease secondary to bacterial pathogens alone is usually significantly higher than in patients with either infection due to nonbacterial pathogens or those with mixed bacterial infection by other organisms.

Pseudomonas and Staphylococcus organisms are the leading isolated pathogens resulting in cavitary lung disease in patients with AIDS.

Suggested Reading

Aviram G, Fishman JE, Sagar M. Cavitary lung disease in AIDS: etiologies and correlation with immune status.
AIDS Patient Care STDS 2001; 15:353–361

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