Bilateral Upper Lobe Pneumocystis carinii Pneumonia in a Patient Receiving Inhaled Pentamidine Prophylaxis

AIDS-related Pneumocystis carinii Pneumonia with Disappearance of Cystic Lesions after Treatment.

“…Since the present case had prophylaxis with aerosol pentamidine, we predicted that pentamidine deposition in the lung periphery might be inadequate, thereby allowing the chronic and low-grade Pneumocystis carinii infection to persist, with subsequent lung destruction and cyst formation. Abdand coworkers measured the regional distribution in the lung of a mixter of technetium-99m diethylenetriaminentaacetic acid and pentamidine administered by means of aerosol to a patient and investigated the diminished deposition of aerosolized pentamidine in the upper lobes of lung ( 12). The present case disclosed PCP-related cysts in the bilateral upper lobes for that reason.…”

Apical Pneumocystis carinii Pneumonia in AIDS Patients Not Receiving Inhaled Pentamidine Prophylaxis

“…4 -6 This was most likely the consequence of poor apical delivery of the aerosol as confirmed by the radiotracer aerosol studies. 4 We have recently encountered two acquired immunodeficiency syndrome patients who received no inhaled pentamidine prophylaxis, yet developed apical P carinii pneumonia. Such atypical presentation of P carini; pneumonia should be differentiated from pulmonary tuberculosis.…”

The Chest Radiograph in the Acquired Immunodeficiency Syndrome

“…Why patients receiving aerocolized pentamidine have a higher incidence of upper lobe PCP is not clear. Abd et al 22 pared with the lower zones. This, and possibly increased removal of inhaled pentamidine from the upper zones compared with the mid and lower zones, explains the increased incidence of upper lobe disease in these patients.…”