Infect Chemother.  2014 Sep;46(3):204-208. 10.3947/ic.2014.46.3.204.

Spontaneous Pneumomediastinum, Pneumopericardium, and Pneumothorax with Respiratory Failure in a Patient with AIDS and Pneumocystis jirovecii Pneumonia

• Park YK
• Jung HC
• Kim SY
• Kim MY
• Jo K
• Kim SY
• Kang B
• Woo G
• Choi HJ
• Wie SH

• KMID: 2284979
• DOI: http://doi.org/10.3947/ic.2014.46.3.204

Abstract

Spontaneous pneumothorax occurs in up to 35% of patients with Pneumocystis jirovecii pneumonia. However, spontaneous pneumomediastinum and pneumopericardium are uncommon complications in patients infected with human immunodeficiency virus, with no reported incidence rates, even among patients with acquired immunodeficiency syndrome (AIDS) and P. jirovecii pneumonia. We report a case of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax with respiratory failure during treatment of P. jirovecii pneumonia in a patient with AIDS; the P. jirovecii infection was confirmed by performing methenamine silver staining of bronchoalveolar lavage specimens. This case suggests that spontaneous pneumomediastinum and pneumopericardium should be considered in patients with AIDS and P. jirovecii pneumonia.

Keyword

Pneumomediastinum; Pneumopericardium; Human immunodeficiency virus; Pneumocystis jirovecii

MeSH Terms

Acquired Immunodeficiency Syndrome
Bronchoalveolar Lavage
HIV
Humans
Incidence
Mediastinal Emphysema*
Methenamine
Pneumocystis jirovecii*
Pneumonia*
Pneumopericardium*
Pneumothorax*
Respiratory Insufficiency*
Methenamine

Figure

• 

  Figure 1 Radiological findings on admission of a 49-year-old man with Pneumocystis jirovecii pneumonia. (A) Chest radiography reveals diffuse infiltrate. (B) Computed tomography reveals diffuse ground glass opacities on both lung fields.

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  Figure 2 Microscopic examination of bronchoalveolar lavage fluid reveals positive foamy exudates by using methenamine silver staining and clusters of cysts morphologically consistent with Pneumocystis jirovecii.

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  Figure 3 Chest radiography showing newly developed pneumomediastinum and pneumopericardium on days 19 (A) and 22 (B) of hospitalization.

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