Nodular granulomatous Pneumocystis carinii pneumonia in a bone marrow transplant recipient - Case report

We report a case of nodular granulomatous Pneumocystis carinii pneumonia fo llowing bone marrow transplantation. The patient was a 40-year-old man who had undergone bone marrow transplanta tion for myeloblastic acute leukemia. He presented with fever, dyspnea and bilateral diffuse nodular infiltration of the lungs. Bronchoalveolar lavage was negative. Open lung biopsy was performed. Histological examination rev ealed a granulomatous reaction with central necrosis surrounded by epitheli oid and giant cells. Toluidine blue and Gomori-Grocott stains identified a few P. carinii. Mycobacterial and fungal cultures were negative. A granulom atous reaction is rarely observed and almost only in HIV-infected patients. To our knowledge this is the first description in a bone marrow transplant recipient.