Granulomatous Pneumocystis jiroveci pneumonia associated with immune reconstituted HIV.

Pneumocystis jiroveci pneumonia uncommonly presents with pulmonary nodules and granulomatous inflammation. An unusual case of granulomatous P jiroveci pneumonia in an HIV patient with a CD4(+) lymphocyte count of greater than 200 cells/mm(3), occurring in the context of immune reconstitution with highly active antiretroviral therapy, is described. The case highlights the importance of establishing this diagnosis to institute appropriate therapy.