Recurrent Pneumocystis pneumonia with normal chest roentgenograms

PNEUMOCYSTIScariniipneumonia is seen in patients with acquired immune deficiencies.1A high index of suspicion is mandatory in the antemortem diagnosis of this infection since it is 100% fatal if not treated. Treatment with pentamidine or cotrimoxazole has been reported to be effective.2Generally, infection is manifested by fever, tachypnea, alveolar infiltrates on chest roentgenograms, and hypoxemia.1However, not all of these signs may be present, and the cause of the patient's respiratory difficulties may be obscure. We report a case of biopsy-proved recurrentPneumocystisinfection in a renal transplant patient with normal chest roentgenograms. Report of a Case An 18-year-old man with renal failure secondary to chronic glomerulonephritis received a kidney from his father in 1970. He received prednisone and azathioprine as antirejection treatment. In 1972, a fibrosarcoma from his right anterior thigh was removed. In 1974, abnormal liver function test results were noted. Azathioprine