A Case of <i>Pneumocystis</i> Pneumonia Diagnosed by Elevation of Serum 1,3-beta-D-glucan and Demonstration of a Cyst in Bronchoalveolar Lavage Fluid Despite No Abnormal CT Findings

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  • Maki Yohei
    Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College
  • Fujikura Yuji
    Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College
  • Sasaki Hisashi
    Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College
  • Hamakawa Yusuke
    Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College
  • Tagami Yoichi
    Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College
  • Hayashi Nobuyoshi
    Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College
  • Kawana Akihiko
    Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College

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Other Title
  • CTで異常所見を認めず1,3-β-Dグルカン上昇と気管支肺胞洗浄液中の菌体確認より診断したニューモシスチス肺炎の1例

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<p>Background. Pneumocystis pneumonia (PCP) often occurs in immunocompromised hosts and is difficult to differentiate from colonization of Pneumocystis jirovecii. For diagnosis of PCP, triad (fever, dry cough, and dyspnea) and the confirmation of fungus body in bronchoalveolar fluid are important findings. Other diagnostic tools include the serum 1,3-β-D-glucan (BDG) level. Chest X-ray and CT typically demonstrate patchy ground-glass shadows and infiltration in both lungs. Case. A 29-year-old man visited our department with a chief complaint of fever and dry cough. HIV screening test was positive and CD4+ T cell count was 197/μl. Despite no hypoxia and no abnormal radiographic findings, PCP was diagnosed by elevation of serum BDG level and confirmation of cysts of Pneumocystis jirovecii in bronchoalveolar lavage fluid. As the result of antibiotic therapy after diagnosis, symptoms and serum BDG level improved. Conclusion. If the radiological imaging demonstrates no abnormal findings, bronchoalveolar lavage is useful to diagnosis PCP in cases in which immunocompromised patient have complaints and elevated serum BDG level.</p>

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