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Case Reports
. 2018 Aug 17:25:147-149.
doi: 10.1016/j.rmcr.2018.08.008. eCollection 2018.

Simultaneous bilateral pneumothorax in an immunocompromised HIV patient with Pneumocystis jirovecii pneumonia

Cristina Matesanz López  1 , Andrés Felipe Cardona Arias  2 , María Teresa Río Ramírez  1 , Gonzalo Díaz Ibero  3 , Sergio Julio Rodríguez Álvarez  2 , María Antonia Juretschke Moragues  1
Affiliations
Case Reports

Simultaneous bilateral pneumothorax in an immunocompromised HIV patient with Pneumocystis jirovecii pneumonia

Cristina Matesanz López et al. Respir Med Case Rep. .

Abstract

Pneumocystis in humans is caused by a unicellular and eukaryotic organism called P. jirovecii. The overall incidence of P. jirovecii pneumonia (PCP) has decreased with the use of highly active antiretroviral therapy and the use of chemoprophylaxis with trimethroprim sulfametoxazole (TMP/SMX) in cases of immunosuppressed patients. However, approximately 85% of patients with advanced HIV infections continue to experience this disease with inadequate management. Pneumocystis infection can present with spontaneous pneumothorax in 2-6% of cases [8] which can be a potentially fatal complication. We report the case of a 32-year-old man presented with P. jirovecii pneumonia who developed cystic lesions and spontaneous bilateral pneumothorax in spite of TMP/SMX treatment. We consider it an interesting clinical case because few simultaneous bilateral pneumothorax cases have been described directly related to the PCP.

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Figures

Fig. 1
Fig. 1
Initial simple-chest-X-ray. Posterior-anterior (PA) projection. It shows diffuse bilateral basal infiltrates.
Fig. 2
Fig. 2
First chest CT shows ground-glass opacities on both upper lung lobes and consolidations areas in lower lung lobes.
Fig. 3
Fig. 3
Follow-up chest CT. It shows an improvement in ground-glass opacities and consolidations areas with multiple cysts as new radiological findings. There could be seen both pneumothorax with both thoracostomy tubes and subcutaneous emphysema.
See this image and copyright information in PMC

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