AIDSAIDS

2012 9 2 A. W.

40

38

2 1 1cm

CT

15 24 :

178cm, 61kg, , BP 108/60mmHg,

HR 82/min , BT 37,6 , SpO 95%(room air)

WBC 4800 /μ

RBC 3.05 10 /μ

Hb 10.2g/

Ht 30.2%

Plt 19.2 104 /μ

Neutro 69.5%

Lympho 16.7%

Mono 10.3%

Eosio 3.1%

Baso 0 .4%

Na 136 mmol/

K 4.0 mmol/

Cl 105 mmol/

Ca 8.7 mg/d

AST 18 IU/

ALT 10 IU/

LDH 245 IU/

ChE 206 IU/

ALP 301 IU/

-GT 56 IU/

T-Bil 0.4 mg/

TP 7.4 g/

Alb 2.9 g/

UN 13 mg/d

Cr 0.81 mg/

Fe 29 g/d

UIBC 200 g/d

Ferritin 855 ng/m

PT 99 %

APTT 44.9 sec

Fbg 544 mg/d

D-D 1.0μg/d

CRP 2.24 mg/

ESR 85 mm

X

CT

spare

RF 3.2 IU/m

IgG 1849 mg/d

BNP 8.7 pg/m

-D 48.5 pg/m

S-IL2R 1440 U/m

KL-6 1319 U/m

SP-D 95.3 ng/m

HIV-1 WB (+)

EIA 8.3

CD4/CD8 0.29

CD4 118/μ

(-)

(-)

room air

pH 7.431

PaO2 70.7 mmHg

PaCO2 37.2 mmHg

HCO3 24.3 mEq/

A-a gradient 32.5mmHg

SpO 95%

crackle

-D 48.5pg/m

KL-6 LDH

HIV CD4 200/μ

AIDS

ST

21

HIV-PCP non-HIV-PCPHIV-PCP Non-HIV-PCP

HIV

AIDS 40% PCP

• Wegenar

RA

•

•

•

HIV

10 20 19 40

CD4

CD4 200/μl

Sadatomo Tasaka et al.”Comparison of Cinical and Radiological Features of Pneumocystis Pneumonia Between

Malignancy Cases and Acquired Immunodeficiency Syndrome Cases”,Ann.Intern.Med. 49;273-281,2010

. AIDS . 69;112-122.2010

[ -D ]

31.1pg/m 92.3%

86.1%

[ ]

X

HIV 10~15%

HRCT 100% 83~90% HIV

[BAL]

HIV 95% PCP non-HIV 38~53%

[PCR]

HIV 72~100% non-HIV 87.2%

HIV 86~100% non-HIV 92.2%Tasaka S., et al. Chest 131;1173-1180. 2007

Hidalgo A et al.,” Accuracy of high-resolution CT in distinguishing between Pneumocystis carinii

pneumonia and non- Pneumocystis carinii pneumonia in AIDS patients.”, Eur Radiol.13;1179-84. 2002

crazy-

paving pattern

AIDS

Jeffrey P. et al., “Pneumocystis jiroveci Pneumonia:High-Resolution CT Findings

in Patients With and Without HIV Infection”,AJR 198;555-561, 2012

,” ”, 20;281-291,2009

HIV-PCP non-HIV-PCP HRCT

Non-AIDS(n=29) AIDS(n=9) p Value

Lung nodules 9(31%) 4(44%) ns

Cystic lesions 1(3%) 5(56%) 0.015

Ground-glass opacity 25(86%) 4(44%) 0.020

Extend of finding

focal 5(17%) 1(11%) ns

extensive 3(10%) 1(11%) ns

diffuse 15(52%) 5(56%) ns

Anatomic distribution

upper lobes 9(31%) 1(11%) ns

lower lobes 5(17%) 3(33%) ns

Emilia Hardak et al.,”Radiological Features of Pneumocystis jirovecii Pneumonia in

Immunocompromised Patients with and without AIDS”,Lung 188;159-163,2010

•TNF

•

Goodman PC.” Pneumocystis carinii pneumonia.” J Thorac Imaging 6 ;16-21,1991

Marutsuka K et al.” Cavitating pneumocystis pneumonia in an autopsied case of adult T-cell

leukemia.” Int J Hematol 56;233-237,1992

3

AIDS

AIDS

AIDS