Nodular granulomatous Pneumocystis jiroveci pneumonia consequent to delayed immune reconstitution inflammatory syndrome

Int J STD AIDS. 2018 Dec;29(14):1451-1453. doi: 10.1177/0956462418787603. Epub 2018 Aug 16.


Although Pneumocystis jiroveci pneumonia (PCP) is a frequent manifestation of acquired immune deficiency syndrome (AIDS), the granulomatous form is uncommon. Here, we present an unusual case of granulomatous PCP consequent to immune reconstitution inflammatory syndrome (IRIS) after highly active antiretroviral therapy. A 36-year-old woman with human immunodeficiency virus (HIV) presented with cough and dyspnea that were attributed to typical PCP associated with AIDS. She was successfully treated with antibiotic, steroid, and antiretroviral therapies. After six months, however, she presented with consolidating lung lesions caused by bronchial obstruction from PCP granulomatous disease. Although antibiotics were ineffective, the effectiveness of steroid therapy suggested a diagnosis of granulomatous IRIS caused by persistent PCP antigens. Physicians should strongly suspect PCP in HIV-positive patients with nodular lung lesions and must remain aware that these lesions, if immune in origin, might not respond to antimicrobial therapy.

Keywords: HIV; Pneumocystis jiroveci pneumonia; granulomatous Pneumocystis jiroveci pneumonia; immune reconstitution inflammatory syndrome; nodular Pneumocystis jiroveci pneumonia.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Infective Agents, Urinary / therapeutic use
  • Antiretroviral Therapy, Highly Active / adverse effects*
  • Bronchoscopy
  • Female
  • Granuloma, Respiratory Tract / complications
  • Granuloma, Respiratory Tract / diagnosis*
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / microbiology
  • Humans
  • Immune Reconstitution Inflammatory Syndrome / complications*
  • Immune Reconstitution Inflammatory Syndrome / drug therapy
  • Immunocompromised Host
  • Lung / diagnostic imaging*
  • Pneumocystis carinii / immunology
  • Pneumocystis carinii / isolation & purification*
  • Pneumonia, Pneumocystis / diagnosis*
  • Pneumonia, Pneumocystis / drug therapy
  • Prednisone / therapeutic use
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination


  • Anti-Infective Agents, Urinary
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Prednisone