PNEUMOCYSTIS-CARINII PLEURAL EFFUSION - PATHOGENESIS AND PLEURAL FLUID ANALYSIS

We present three new cases of Pneumocystis carinii in pleural effusion s of patients with AIDS, bringing the total number of reported cases t o six. In our patients, diagnosis was made by visualization of Pneumoc ystis in pleural fluid stained with Gomori methenamine silver. LDH was greater than 400, and pleural fluid to serum LDH ratio was greater th an 1.0 in all cases at time of presentation. All six reported patients have been associated with aerosolized pentamidine, and five of the si x had documented underlying Pneumocystis pneumonia. The sixth patient, which we report, presented with primary pleural infection with Pneumo cystis. Although we could not document underlying pneumonia, we suspec t ft was present. Pneumocystis pleural disease appears to be an anatom ic extension of smoldering subpleural Pneumocystis pneumonia, and prog nosis is not worse than with pneumonia alone.