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Case report
peer-reviewed

A Case of Localized Pulmonary Calcification Presenting as a Persistent Mass Lesion in an Immunosuppressed Patient Following Treatment of a Pseudomonas Pneumonia



Abstract

We report a case of a persistent right upper lobe opacity following treatment for a Pseudomonas infection in an immunosuppressed patient with a recent renal transplantation. The patient underwent a surgical lung biopsy for definitive diagnosis of the mass. The lesion was composed of extensive calcifications deposited throughout the lung with associated fibrosis. The patient had a history of a remote parathyroidectomy for hyperparathyroidism; however, the parathyroid hormone (PTH) and the calcium levels were still mildly elevated. No other calcified lung lesions had developed in a follow-up after the initial resection. Pulmonary calcification has been classically associated with varicella pneumonia; no viral cytopathic changes were identified for varicella or other viruses in this case. The calcification appears to be secondary to the recent Pseudomonas pneumonia. To our knowledge, this is the first report of a Pseudomonas pneumonia resulting in extensive localized pulmonary calcification. This is an important diagnostic consideration as this benign entity should be considered in patients with persistent opacities following treatment for pneumonia.



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Case report
peer-reviewed

A Case of Localized Pulmonary Calcification Presenting as a Persistent Mass Lesion in an Immunosuppressed Patient Following Treatment of a Pseudomonas Pneumonia


Author Information

Matthew J. Cecchini Corresponding Author

Department of Pathology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA

Dominic L. Shepherd

Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA

Jessica G. Shepherd

Department of Pathology and Laboratory Medicine, London Health Science Centre


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Patient consent is waived as this is a pathology case report. All nonrelevant history and demographics have been removed from the case to protect patient identity. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Acknowledgements

Matthew J. Cecchini and Dominic L. Shepherd contributed equally to this work.


Case report
peer-reviewed

A Case of Localized Pulmonary Calcification Presenting as a Persistent Mass Lesion in an Immunosuppressed Patient Following Treatment of a Pseudomonas Pneumonia


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Case report
peer-reviewed

A Case of Localized Pulmonary Calcification Presenting as a Persistent Mass Lesion in an Immunosuppressed Patient Following Treatment of a Pseudomonas Pneumonia

Matthew J. Cecchini">Matthew J. Cecchini , Dominic L. Shepherd">Dominic L. Shepherd, Jessica G. Shepherd">Jessica G. Shepherd

  • Author Information
    Matthew J. Cecchini Corresponding Author

    Department of Pathology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA

    Dominic L. Shepherd

    Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA

    Jessica G. Shepherd

    Department of Pathology and Laboratory Medicine, London Health Science Centre


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Patient consent is waived as this is a pathology case report. All nonrelevant history and demographics have been removed from the case to protect patient identity. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements

    Matthew J. Cecchini and Dominic L. Shepherd contributed equally to this work.


    Article Information

    Published: October 11, 2017

    DOI

    10.7759/cureus.1765

    Cite this article as:

    Cecchini M J, Shepherd D L, Shepherd J G (October 11, 2017) A Case of Localized Pulmonary Calcification Presenting as a Persistent Mass Lesion in an Immunosuppressed Patient Following Treatment of a Pseudomonas Pneumonia. Cureus 9(10): e1765. doi:10.7759/cureus.1765

    Publication history

    Received by Cureus: August 28, 2017
    Peer review began: September 08, 2017
    Peer review concluded: October 08, 2017
    Published: October 11, 2017

    Copyright

    © Copyright 2017
    Cecchini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

We report a case of a persistent right upper lobe opacity following treatment for a Pseudomonas infection in an immunosuppressed patient with a recent renal transplantation. The patient underwent a surgical lung biopsy for definitive diagnosis of the mass. The lesion was composed of extensive calcifications deposited throughout the lung with associated fibrosis. The patient had a history of a remote parathyroidectomy for hyperparathyroidism; however, the parathyroid hormone (PTH) and the calcium levels were still mildly elevated. No other calcified lung lesions had developed in a follow-up after the initial resection. Pulmonary calcification has been classically associated with varicella pneumonia; no viral cytopathic changes were identified for varicella or other viruses in this case. The calcification appears to be secondary to the recent Pseudomonas pneumonia. To our knowledge, this is the first report of a Pseudomonas pneumonia resulting in extensive localized pulmonary calcification. This is an important diagnostic consideration as this benign entity should be considered in patients with persistent opacities following treatment for pneumonia.



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Matthew J. Cecchini, M.D., Resident Physician, Ph.D.

Department of Pathology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA

For correspondence:
matt.cecchini@lhsc.on.ca

Dominic L. Shepherd

Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA

Jessica G. Shepherd

Department of Pathology and Laboratory Medicine, London Health Science Centre

Matthew J. Cecchini, M.D., Resident Physician, Ph.D.

Department of Pathology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA

For correspondence:
matt.cecchini@lhsc.on.ca

Dominic L. Shepherd

Schulich School of Medicine & Dentistry, Western University, London, Ontario, CA

Jessica G. Shepherd

Department of Pathology and Laboratory Medicine, London Health Science Centre