Pneumocystis jiroveci Pneumonia Mimicking Miliary Tuberculosis in a Kidney Transplanted Patient.

Jung, Ju Young; Rhee, Kyoung Hoon; Koo, Dong Hoe; Park, I Nae; Shim, Tae Sun

doi:2009.67.2.127

Tuberc Respir Dis > Volume 67(2); 2009 > Article

Case Report

Tuberculosis and Respiratory Diseases 2009;67(2):127-130.
DOI: https://doi.org/10.4046/trd.2009.67.2.127 Published online August 1, 2009.

Pneumocystis jiroveci Pneumonia Mimicking Miliary Tuberculosis in a Kidney Transplanted Patient.

Ju Young Jung, Kyoung Hoon Rhee, Dong Hoe Koo, I Nae Park, Tae Sun Shim

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. shimts@amc.seoul.kr

Abstract

Bilateral interstitial infiltration in chest radiography, which may be fine granular, reticular or of ground glass opacity, is the typical radiographic findings of Pneumocystis jiroveci pneumonia. Recently, atypical radiographic features, including cystic lung disease, spontaneous pneumothorax or nodular opacity, have been reported intermittently in patients with P. jiroveci pneumonia. We report the case of a 29-year-old woman with a transplanted kidney whose simple chest radiography and HRCT scan showed numerous miliary nodules in both lungs, mimicking miliary tuberculosis (TB). Under the presumptive diagnosis of miliary TB, empirical anti-TB medication was started. However, Grocott methenamine silver nitrate staining of a transbronchial lung biopsy tissue revealed P. jiroveci infection without evidence of TB. These findings suggest that even in TB-endemic area other etiology such as P. jiroveci as well as M. tuberculosis should be considered as an etiology of miliary lung nodules in immunocompromised patients.

Key Words: Pneumocystis carinii (Pneumocystis jiroveci), Kidney transplantation, Bronchoscopy, Tuberculosis, Miliary