Comparison of Clinical and Radiological Features of Pneumocystis Pneumonia Between Malignancy Cases and Acquired Immunodeficiency Syndrome Cases: A Multicenter Study

Sadatomo Tasaka; Hitoshi Tokuda; Fumikazu Sakai; Takeshi Fujii; Kazuhiro Tateda; Takeshi Johkoh; Norio Ohmagari; Hiromitsu Ohta; Hideki Araoka; Yoshimi Kikuchi; Masahide Yasui; Kanako Inuzuka; Hajime Goto

doi:10.2169/internalmedicine.49.2871

ORIGINAL ARTICLES

Comparison of Clinical and Radiological Features of Pneumocystis Pneumonia Between Malignancy Cases and Acquired Immunodeficiency Syndrome Cases: A Multicenter Study

Sadatomo Tasaka, Hitoshi Tokuda, Fumikazu Sakai, Takeshi Fujii, Kazuhiro Tateda, Takeshi Johkoh, Norio Ohmagari, Hiromitsu Ohta, Hideki Araoka, Yoshimi Kikuchi, Masahide Yasui, Kanako Inuzuka, Hajime Goto

Author information

Sadatomo Tasaka
Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine
Hitoshi Tokuda
Department of Internal Medicine, Social Health Insurance Central General Hospital
Fumikazu Sakai
Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University
Takeshi Fujii
Department of Infectious Diseases and Applied Immunology, Institute of Medical Science, University of Tokyo
Kazuhiro Tateda
Department of Microbiology and Infectious Diseases, Toho University School of Medicine
Takeshi Johkoh
Department of Radiology, Kinki Central Hospital
Norio Ohmagari
Division of Infectious Diseases, Shizuoka Cancer Center
Hiromitsu Ohta
Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging, and Cancer, Tohoku University
Hideki Araoka
Department of Infectious Disease, Toranomon Hospital
Yoshimi Kikuchi
AIDS Clinical Center, International Medical Center of Japan
Masahide Yasui
Division of Respiratory Medicine, Kanazawa Municipal Hospital
Kanako Inuzuka
Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science
Hajime Goto
Department of Respiratory Medicine, Kyorin University School of Medicine

Keywords: pneumocystis pneumonia, computed tomography, ground-glass opacity, malignancy, acquired immunodeficiency syndrome

JOURNAL OPEN ACCESS

2010 Volume 49 Issue 4 Pages 273-281

DOI https://doi.org/10.2169/internalmedicine.49.2871

Details

Abstract

Background The clinical features of pneumocystis pneumonia (PCP) differ according to the predisposing factors responsible for immunosuppression. Although PCP in patients with acquired immunodeficiency syndrome (AIDS) has been extensively described, its characteristics in non-AIDS patients, such as those with malignancies, are not thoroughly documented.
Study objective To characterize and compare the clinical and imaging features of PCP in patients with malignancies with those in AIDS patients.
Design A multi-center retrospective study.
Patients and Measurements We evaluated the clinical and radiological features of PCP in 21 patients with malignancies and in 17 with AIDS. Clinical presentation, serum markers, oxygenation, CT findings, and outcome were examined.
Results The patients with malignancies showed shorter durations of symptoms before PCP was diagnosed. The levels of serum markers and the oxygenation index did not differ. CT showed diffuse or widespread ground-glass opacity (GGO) in all of the patients evaluated. None of the AIDS patients demonstrated consolidation, whereas half of the patients with malignancy showed consolidation along with GGO. The extent of GGO scored on CT images was significantly greater in the AIDS patients. No correlation was observed between the CT findings and other clinical parameters. All of the AIDS patients recovered from PCP, whereas six patients with malignancies died within a month after the onset of PCP.
Conclusion The characteristics of the CT images differed between the patient groups with different underlying disorders, although it remains to be determined whether CT findings are associated with other clinical features or are predictive of the outcome of PCP.

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