Spontaneous pneumothorax in a patient with pneumocystis pneumonia

Description

A woman aged 35 years presented with a 6-week history of worsening shortness of breath. She previously had TB in her early 20s, but had no other medical history of note. She had been referred several months earlier due to an abnormal chest X-ray suggestive of an interstitial lung disease but had not attended. She has previously been an intravenous drug user.

The patient had intermittent fever and rigors, night sweats, diaphoresis and diarrhoea. At admission, she was cachectic and tachypnoeic, with clubbing and cervical lymphadenopathy.

An HIV test was found to be positive, with a CD4 count of 101 cells/mm³. The initial chest radiograph showed diffuse alveolar shadowing. CT imaging and bronchoscopy confirmed pneumocystis pneumonia. Cystic lesions in the lung, consistent with pneumatoceles, were visible on CT thorax (figure 1). She was treated with cotrimoxazole and prednisolone.

Figure 1

CT showing pneumatocoeles prepneumothorax.

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