Granulomatous Reaction to Pneumocystis jirovecii Diagnosed in a Bronchoalveolar Lavage: A Case Report.

Détails

ID Serval
serval:BIB_CC29FC2CEAF7
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Etude de cas (case report): rapporte une observation et la commente brièvement.
Collection
Publications
Titre
Granulomatous Reaction to Pneumocystis jirovecii Diagnosed in a Bronchoalveolar Lavage: A Case Report.
Périodique
Acta cytologica
Auteur(s)
Nobile A., Valenti A., Aubert J.D., Beigelman C., Letovanec I., Bongiovanni M.
ISSN
1938-2650 (Electronic)
ISSN-L
0001-5547
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
59
Numéro
3
Pages
284-288
Langue
anglais
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Résumé
Granulomatous reaction to Pneumocystis jirovecii is a rare but well-known pathological finding encountered in the setting of immunosuppression, HIV infection being the most common cause. It can also potentially complicate the treatment of hematological malignancies, typically when drugs lowering the count and function of lymphocytes are used. Lung biopsy is considered the gold standard for the diagnosis of granulomatous P. jirovecii pneumonia, whereas the diffuse alveolar form is usually detected cytologically in bronchoalveolar lavage (BAL).
A female patient pursuing R-CHOP chemotherapy for the treatment of multiple hematological malignancies developed a rapidly progressing dyspnea. Chest CT scans revealed a worsening of a known infiltrative lung disease thought to be secondary to her chemotherapy. Alterations compatible with a drug-induced interstitial lung disease and well-formed focally necrotizing granulomas were observed on an open lung biopsy, but no microorganism was identified with special stains. Eventually, a granulomatous reaction to P. jirovecii was found in a BAL and allowed appropriate treatment with rapid improvement of the dyspnea.
Because granulomas are tissue-bound structures, they are rarely described in BAL. This article describes the first reported cytological diagnosis of a granulomatous reaction to P. jirovecii and the potential diagnostic interest of such a peculiar finding.

Mots-clé
Aged, Antibodies, Monoclonal, Murine-Derived/adverse effects, Antineoplastic Combined Chemotherapy Protocols/adverse effects, Bronchoalveolar Lavage Fluid/microbiology, Cyclophosphamide/adverse effects, Doxorubicin/adverse effects, Female, Granuloma, Respiratory Tract/etiology, Granuloma, Respiratory Tract/pathology, Hematologic Neoplasms/complications, Hematologic Neoplasms/drug therapy, Hematologic Neoplasms/pathology, Humans, Immunocompromised Host, Pneumocystis carinii/isolation & purification, Pneumonia, Pneumocystis/microbiology, Pneumonia, Pneumocystis/pathology, Prednisone/adverse effects, Prognosis, Vincristine/adverse effects
Pubmed
Web of science
Création de la notice
29/06/2015 10:42
Dernière modification de la notice
20/08/2019 16:46
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