Pneumothorax in Pneumocystis Jirovecii Pneumonia: A case report, review of clinical characteristics and management

Background: Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection that occurs in immunosuppressed populations, primarily patients with advanced human immunodeficiency virus (HIV) infection. Pneumothorax complicates 5% of PCP and may be the initial presentation in about 6% of cases. Pneumothorax portends a poor prognosis for patients with HIV infection, and management can be complicated and unsatisfactory.
Case Report: We present a young Caucasian female, initially diagnosed as having community acquired pneumonia (CAP) but later found to be PCP. Subsequently the patient developed pneumatoceles and pneumothorax. We review the clinical characteristics of and current concepts for the management of PCP associated pneumothorax.
Conclusions: PCP still remains an important AIDS defining illness and still represents a significant index presentation. PCP should be considered in pneumonias with multilobar and cystic features in relatively healthy young adults. Pneumothorax is a very important complication of PCP and can present in a subtle fashion. Cysts and pneumatoceles on radiographs should warrant close observation and follow up. Management of PCP associated pneumothorax is complicated and difficult. No one technique is consistently successful and there is no agreement on the best modality of therapy for complicated cases. Pneumothorax in the setting of PCP portends signifi cantly higher morbidity and mortality.

Keywords: Pneumocystis jirovecii pneumonia, Pneumothorax, Pneumonia