Pneumocystis pneumonia complicated by extensive diffuse pneumatoceles

A 60-year-old male presented to the outpatient clinic with shortness of breath, subjective fevers, and night sweats of one month duration. Initial chest X-ray revealed new bilateral perihilar consolidations. He was treated with a 5-day course of levofloxacin 750 mg daily without improvement. Therefore, he underwent a chest CT scan which showed extensive bilateral pneumatoceles (Figure 1, A). Bronchoscopy with BAL was positive for Pneumocystis jirovecii on PCR. Laboratory workup revealed lymphopenia with lymphocyte count of 0.41 × 10(9)/L and CD4 count of 40 cells/mm3.