Granulomatous Pneumocystis jiroveci Pneumonia in a Patient with Chronic Lymphocytic Leukemia: A Literature Review and Hypothesis on Pathogenesis

The limited information available from these studies suggests that these patients have immune reconstitution-like syndrome related to either increasing numbers of CD4 + lymphocytes following therapeutic suppression or impaired modulation of CD4 + function. This unusual clinical presentation may delay diagnosis and effective therapy.