AIDS-related Pneumocystis carinii Pneumonia with Disappearance of Cystic Lesions after Treatment.

Abstract

A 21-year-old hemophiliac with human immunodeficiency virus (HIV) infection was admitted to our hospital because of bilateral pneumothoraces associated with Pneumocystis carinii pneumonia (PCP). He underwent chest tube drainages and intravenous pentamidine therapy, resulting in clinical improvement. Twomonths after treatment for PCP, cystic lesions that had existed before treatment disappeared on chest computed tomography. Weconcluded that Pneumocystis carinii infection might be associated with lung destruction and cyst formation, and that inflammatory exudates in the small bronchioles might act as a ball-valve with subsequent spontaneous pneumothoraces. (Internal Medicine 41: 896-898, 2002)

Pneumomediastinum in patients with AIDS: a case report and literature review

“…9 Although the overall incidence of PJP has decreased in the era of HAART, 10 85% of patients with advanced HIV infections have continued to experience PJP in the course of their disease. 11 The common radiographic finding in PJP is diffuse interstitial infiltration, 12 but some atypical presentations, such as cystic or nodular lesions and pneumothorax have been reported. Pneumomediastinum is a rare complication of PJP and the prevalence ranges from 0.4% to 3.3%.…”

Newly formed cystic lesions for the development of pneumomediastinum in Pneumocystis jirovecii pneumonia

“…However, approximately 85% of patients with advanced HIV infections continue to experience P. jirovecii pneumonia in the course of their disease when management is inadequate [5]. The most common radiographic finding in P. jirovecii pneumonia is the presence of diffuse, bilateral perihilar interstitial infiltrates (ground-glass opacity) in both lungs [6].…”

“…The exact mechanism behind the development of the pulmonary cysts and P. jirovecii is not yet known. However, various mechanisms have been proposed including direct lung destruction by P. jirovecii , over-distension of the lungs caused by obstructive bronchiolitis acting as a ball-valve (inflammatory exudates in the small bronchioles), interstitial emphysema and abnormal remodeling of pulmonary architecture due to interstitial fibrosis, and release of elastase and other proteolytic enzymes [5,10-12]. A review of the literature indicates that the development of spontaneous pneumomediastinum with subcutaneous emphysema in HIV patients is rare.…”

Pneumocystis jirovecii Pneumonia Complicated by Pneumomediastinum: A Case Report

“…The prognosis depends on the severity of the underlying lung disease and the timely recognition and management of complications like pneumomediastinum. These include the action of proteolytic enzymes and the destruction of lung parenchyma by P. jirovecii result in cyst formation and interstitial fibrosis [8][9][10][11].…”