Spontaneous Pneumothorax Developing during Pneumocystis jirovecii Pneumonia: A Case Report

Year 2025, Volume: 15 Issue: 3, 515 - 519, 24.09.2025

Oğuz Karabay , Yasin Kara , Güven Çelebi , Hande Moralı , Aslı Vatan , Ertuğrul Güçlü

https://doi.org/10.33631/sabd.1589201

Abstract

This presentation discusses a case of spontaneous pneumothorax in an individual living with Human immunodeficiency virus (HIV) undergoing treatment for Pneumocystis jirovecii pneumonia (PJP). A 36-year-old individual living with HIV developed respiratory distress and a decrease in oxygen saturation while receiving co-trimoxazole treatment with a diagnosis of PJP. A chest X-ray revealed a left pneumothorax, and thoracentesis with tube thoracostomy was performed by thoracic surgery. The lung expanded after the procedure, but the patient died on the 29th day of follow-up in our center due to complications during the treatment process. Infection management in advanced Acquired Immune Deficiency Syndrome (AIDS) patients should be conducted carefully, with potential complications closely monitored. The risk of pneumothorax should be kept in mind during the course of PJP.

Keywords

Pneumocystis jirovecii pneumonia , spontaneous pneumothoraks , HIV , AIDS , Case report

Pneumocystis jirovecii Pnömonisi Seyrinde Gelişen Spontan Pnömotoraks: Olgu Sunumu*

Abstract

Bu sunumda, insan immün yetmezlik virüsü (HIV) ile yaşayan ve Pneumocystis jirovecii pnömonisi (PJP) tedavisi gören bir bireyde gelişen spontan pnömotoraks olgusu ele alınmıştır. HIV ile yaşayan 36 yaşındaki birey, PJP tanısı ile ko-trimoksazol tedavisi alırken, solunum sıkıntısı ve oksijen saturasyonunda düşüş gelişmiştir. Akciğer grafisinde sol pnömotoraks saptanmış ve göğüs cerrahisi tarafından torasentez ile tüp torakostomi uygulanmıştır. İşlem sonrası akciğer ekspanse olmuş ancak hasta, tedavi sürecinde komplikasyonlar nedeniyle merkezimizdeki takibinin 29. gününde hayatını kaybetmiştir. İleri evre Edinsel İmmun Yetmezlik Sendromu (AIDS) olan bireylerde enfeksiyon yönetimi dikkatli bir şekilde yapılmalı ve potansiyel komplikasyonlar izlenmelidir. PJP seyri sırasında pnömotoraks riski akılda tutulmalıdır.

Keywords

Pneumocystis jirovecii pnömonisi , spontan pnömotoraks , HIV , AIDS

References

• Terzi E, Zarogoulidis K, Kougioumtzi I, Dryllis G, Kioumis I, Pitsiou G, et al. Human immunodeficiency virus infection and pneumothorax. J Thorac Dis. 2014;6(Suppl 4):S377–82.
• Kıymaz YÇ, Büyüktuna SA. Miliary Pneumocystis jiroveci pneumonia in a patient living with HIV. Int J STD AIDS. 2024;35(12):999-1001.
• Wills NK, Adriaanse M, Erasmus S, Wasserman S. Chest X-ray features of HIV-associated Pneumocystis pneumonia (PCP) in adults: a systematic review and meta-analysis. Open Forum Infect Dis. 2024;11(4):ofae146.
• Suwanwongse K, Shabarek N. Tension Pneumothorax following Pneumocystis jirovecii Pneumonia. Cureus. 2020;12(1):e6799.
• McClellan MD, Miller SB, Parsons PE, Cohn DL. Pneumothorax with Pneumocystis carinii pneumonia in AIDS. Incidence and clinical characteristics. Chest. 1991;100(5):1224-8.
• Beers MF, Sohn M, Swartz M. Recurrent pneumothorax in AIDS patients with Pneumocystis pneumonia. A clinicopathologic report of three cases and review of the literature. Chest. 1990;98(2):266-70.
• She WH, Chok KSH, Li IWS, Ma KW, Sin SL, Dai WC, et al. Pneumocystis jirovecii-related spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in a liver transplant recipient: a case report. BMC Infect Dis. 2019;19(1):66.
• Çakır Y, Ince N, Çalışkan E. Bir üniversite hastanesi enfeksiyon hastalıkları polikliniğinde takip edilen HIV pozitif hastaların aşılanma durumu. OTSBD. 2022;7(3):407-13.
• Ibrahim A, Chattaraj A, Iqbal Q, Anjum A, Rehman MEU, Aijaz Z, et al. Pneumocystis jirovecii pneumonia: a review of management in human immunodeficiency virus (HIV) and non-HIV immunocompromised patients. Avicenna J Med. 2023;13(1):23-34.
• Wang Y, Zhou X, Saimi M, Huang X, Sun T, Fan G, et al. Risk factors of mortality from Pneumocystis pneumonia in non-HIV patients: a meta-analysis. Front Public Health. 2021;9:680108.
• Tumbarello M, Tacconelli E, Pirronti T, Cauda R, Ortona L. Pneumothorax in HIV-infected patients: role of Pneumocystis carinii pneumonia and pulmonary tuberculosis. Eur Respir J. 1997;10(6):1332-5.
• Feng Q, Hao J, Li A, Tong Z. Nomograms for death from Pneumocystis jirovecii pneumonia in HIV-uninfected and HIV-infected patients. Int J Gen Med. 2022;15:3055-67.
• Afessa B. Pleural effusion and pneumothorax in hospitalized patients with HIV infection: the Pulmonary Complications, ICU support, and Prognostic Factors of Hospitalized Patients with HIV (PIP) Study. Chest. 2000;117(4):1031-7.
• Martínez-Vázquez C, Seijas M, Ocampo A, López A, Oliveira I, Sopeña B, et al. Pneumothorax in patients infected by the human immunodeficiency virus. An Med Interna. 2001;18(10):521-4.
• Gómez G, Martínez C, Rozas F, Pérez G, Lera M, Gómez J. Spontaneous pneumothorax associated with human immunodeficiency virus (HIV) infection. Arch Bronconeumol. 1998;34(4):184-8.
• Noppen M. Spontaneous pneumothorax: epidemiology, pathophysiology and cause. Eur Respir Rev. 2010;19(117): 217-9.
• Choi JS, Kwak SH, Kim MC, Seol CH, Kim SR, Park BH, et al. Clinical impact of pneumothorax in patients with Pneumocystis jirovecii pneumonia and respiratory failure in an HIV-negative cohort. BMC Pulm Med. 2022;22(1):7.
• Schoenenberger RA, Haefeli WE, Weiss P, Ritz RF. Timing of invasive procedures in therapy for primary and secondary spontaneous pneumothorax. Arch Surg. 1991;126(6):764-6.
• Zantah M, Dominguez Castillo E, Townsend R, Dikengil F, Criner GJ. Pneumothorax in COVID-19 disease- incidence and clinical characteristics. Respir Res. 2020;21(1):236.
• Cho YM, Guevara S, Aronsohn J, Mumford JM, Shore-Lesserson L, Miyara SJ, et al. Bilateral spontaneous pneumothorax in a COVID-19 and HIV-positive patient: a case report. Front Med (Lausanne). 2021;8:698268.
• Liu K, Zeng Y, Xie P, Ye X, Xu G, Liu J, et al. COVID-19 with cystic features on computed tomography: a case report. Medicine (Baltimore). 2020;99(18):e20175.
• Hollingshead C, Hanrahan J. Spontaneous pneumothorax following COVID-19 pneumonia. IDCases. 2020;21:e00868.
• miró ò, llorens p, jiménez s, piñera p, burillo-putze g, martín a, et al. frequency, risk factors, clinical characteristics, and outcomes of spontaneous pneumothorax in patients with coronavirus disease 2019: a case-control, emergency medicine-based multicenter study. Chest. 2021;159(3):1241-55.
• Ekanem E, Podder S, Donthi N, Bakhshi H, Stodghill J, Khandhar S, et al. Spontaneous pneumothorax: an emerging complication of COVID-19 pneumonia. Heart Lung. 2021;50(3):437-40.