Pneumocystis carinii pneumonia is a disease of considerable severity, particularly in debilitated newborn infants or in children with hypogammaglobulinemia (14). While the childhood disease has received attention in the radiologic literature (1, 2, 6, 7, 22), little has been written of its roentgenographic presentation in the adult. With the increasing use of immunosuppressive and cytotoxic drugs in the treatment of human malignant disease and in organ transplantation, Pneumocystis carinii has become an increasingly important clinical entity in adults (17,19, 20, 29). An increased awareness of this disease as a cause of interstitial pneumonia in adults on immunosuppressive therapy should lead to early definitive diagnosis and effective treatment. In a previous publication from this institution, our experience with Pneumocystis carinii pneumonia was reviewed retrospectively, and the need for prompt diagnosis and institution of specific therapy was expressed (27). Subsequently, 2 cases diagnosed by percutaneous needle biopsy were successfully treated with pentamidine isethionate (3), a drug also recommended by others as specific therapy for this disease (21, 23, 25). Since the time of the initial report, percutaneous needle biopsies of the lung have been performed in 6 patients with suspected Pneumocystis infection. The purpose of this communication is to review the technic for needle biopsy and the clinical and roentgenographic presentation of Pneumocystis carinii pneumonia in patients with malignant disease. Clinical Material Detailed case histories of our first two successful biopsies have been previously reported (3). Representative radiographs of these cases are shown in Figures 1 and 2. In addition, we have performed biopsies on 4 additional cases, 2 of which were positive for Pneumocystis carinii. Case III. A. B., an 8-year-old Caucasian girl with a two-year history of acute lymphocytic leukemia, was admitted to the National Cancer Institute on Dec. 2, 1968, with a two-week history of fever, nonproductive cough, and headaches. During the previous few months, the patient's leukemia was becoming more difficult to control, and her last course of combination chemotherapy (6-mercaptopurine, amethopterin, vincristine and prednisone) was completed two weeks prior to admission. On admission, her temperature was 38.5° C and the respiratory rate was 32/min. The chest was clear to percussion and auscultation, The patient's condition was stable until Dec. 6, when her temperature rose to 39° C. After appropriate cultures, ampicillin was administered empirically. The fever remained high, however, and the respiratory rate increased to 60/min. Physical examination of the chest remained negative. The patient's chest roentgenogram is seen in Figure 3. On Dec. 9, a percutaneous lung biopsy was performed, and Pneumocystis organisms were seen on tissue sections.
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Mar 9, 1984
J Bruce Jacobs + 3