Bilateral Spontaneous Pneumothorax in a COVID-19 and HIV-Positive Patient: A Case Report

Abstract

This case report describes a 60 year-old Black-American male with a past medical history of human immunodeficiency virus (HIV) infection and hyperthyroidism, who suffered a bilateral spontaneous pneumothorax (SP) in the setting of coronavirus disease 2019 (COVID-19) pneumonia. SP is a well-established complication in HIV-positive patients and only recently has been associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. While HIV and COVID-19 infections have been independently linked with increased risk of SP development, it is unknown if both infections interact in a synergistic fashion to exacerbate SP risk. According to the Centers for Disease Control and Prevention (CDC), patients living with HIV have a higher risk of developing severe COVID-19 infection and the mechanism remains to be elucidated. To the best of our knowledge, this is the first report of a HIV-positive patient, who in the setting of SARS-CoV-2 infection, developed bilateral apical spontaneous pneumothorax and was later found to have a left lower lobe tension pneumothorax. This case highlights the importance of considering SP on the differential diagnosis when HIV-positive patients suddenly develop respiratory distress in the setting of SARS-CoV-2 infection.

Keywords: COVID-19; HAART; HIV/AIDS; SARS-CoV-2; bilateral pneumothorax; spontaneous pneumothorax; tension pneumothorax.

Figure 1

Contrasted CT scan reveals bilateral lung disease, characterized by: (A) Bilateral pneumothoraces (magenta, red, and green arrows). (B) Interstitial, diffuse infiltrates (blue arrows). (C) Isolated areas of consolidation (orange and yellow arrows). (D) Left lung pneumothorax has its largest prominence in the inferior costophrenic sulcus (red arrows).

Figure 2

Admission Timeline of a 60-year-old Black male with a past medical history of HIV infection with a CD₄ T cell count of 351 cells/mm³ on HAART, HIV encephalopathy, hyperthyroidism, BMI 18.2 kg/m², and no active smoking or respiratory disease presented to the hospital due to worsening confusion, cough, and generalized weakness, diagnosed with COVID-19 pneumonia and bilateral pneumothoraces.