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Refractory granulomatous Pneumocystis jirovecii pneumonia masquerading as malignancy
  1. Chi Wan Koo1,
  2. Ananya Panda2,
  3. Jennifer Boland Froemming1
  1. 1 Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Chi Wan Koo; koo.chiwan{at}mayo.edu

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An elderly female, lifelong non-smoker, with rheumatoid arthritis treated with methotrexate and prednisone for 10 years was referred for evaluation of incidentally detected, randomly distributed pulmonary nodules on a CT performed for pleuritic chest pain and dyspnoea (figure 1A). Subsequent [18F]fluoro-d-glucose (FDG)-positron emission tomography (PET) showed the nodules had increased in size and were FDG-avid (figure 1B). Patient underwent percutaneous biopsy at an external institution with pathology reported to be highly suspicious for lung adenocarcinoma.

Figure 1

(A) CT angiogram performed for evaluation of pleuritic chest pain and dyspnoea demonstrated incidental solid, non-calcified left lower lobe subpleural predominant pulmonary nodules (arrow, additional nodules not shown). Note dependent atelectasis presenting as ground-glass opacities. (B) [18F]fluoro-d-glucose (FDG)-positron emission tomography performed 4 months later showed these nodules had more than doubled in size and were FDG-avid (arrow). No additional FDG avidity was detected elsewhere.

After an unrevealing bronchoscopy with bronchoalveolar lavage, the patient was referred to our institution for further care. Re-evaluation of the previous percutaneous …

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Footnotes

  • X @ChiWanKoo1

  • Contributors CWK: responsible for the conception of this manuscript and for interpretation of data for the work. She drafted the manuscript, approves this version to be published and agrees to be accountable for all aspects of the work. AP: responsible for acquisition and interpretation of radiology data for the manuscript. She contributed to revision of the manuscript critically, approved the latest version to be published and agreed to be accountable for all aspects of the work. JBF: responsible for acquisition and interpretation of pathology data for the manuscript. She contributed to revising the manuscript critically, approved the latest version to be published and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.