Pneumocystis jirovecii-related spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in a liver transplant recipient: a case report

She, Wong Hoi; Chok, Kenneth S. H.; Li, Iris W. S.; Wing, Ka; Sin, Sui Ling; Dai, Wing Chiu; Lo, Chung Mau

doi:10.1186/s12879-019-3723-y

Cited by 18 publications

(21 citation statements)

References 26 publications

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“…A recent study of PCP lung cancer cases found that 67% of patients had diffuse interstitial infiltrates on radiograph, whereas CT showed more typical bilateral GGO in 66% of patients [25]. Other findings include nodules, cystic lesions, pneumothorax and pneumomediastinum, while cavities and unilateral presentation can occasionally occur [10,22,30]. A normal CT may be useful for excluding PCP, particularly in HIV-positive patients [31,32].…”

Section: Clinical Manifestationmentioning

confidence: 99%

Pneumocystis jirovecii Pneumonia: Epidemiology, Clinical Manifestation and Diagnosis

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2019

Curr Fungal Infect Rep

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Purpose of Review The purpose of this study is to provide an understanding of the increased range of patient cohorts at risk of Pneumocystis jirovecii pneumonia (PCP) and describe typical clinical presentations together with advances in diagnostic assays and strategies. Recent Findings The range of immuno-compromised patients at risk of PCP continues to expand. Apart from human immunodeficiency virus (HIV)-positive patients, those with solid tumours or suffering from haematological malignancy, solid organ transplant recipients or with autoimmune and inflammatory conditions receiving immuno-modulating therapies and patients diagnosed with primary immune deficiencies are all at increased risk of PCP. The clinical presentation of respiratory distress may be mild/moderate in the HIV-positive patient, but fulminant in HIV-negative. While typical clinical signs of PCP, along with underlying risk factors and the absence of alternative diagnoses, may be sufficient to commence therapy, every effort should be made to achieve a mycological diagnosis. With the advent of modern diagnostics techniques (real-time polymerase chain reaction (PCR) and (1-3)-β-D-Glucan), a laboratory-based diagnosis should always be attempted, although microscopic identification of Pneumocystis within respiratory samples remains the reference method. By combining different assays, it may be possible to both exclude and confirm PCP, without the need for invasive samples. Summary This review will summarize the epidemiology, clinical manifestations and diagnostic options for PCP, and also briefly cover therapeutic management, the emerging issue of resistance and PCP in paediatric age group.

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Section: Clinical Manifestationmentioning

confidence: 99%

Pneumocystis jirovecii Pneumonia: Epidemiology, Clinical Manifestation and Diagnosis

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2019

Curr Fungal Infect Rep

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“…Pneumothorax has been reported with many infections like Influenza [ 11 ], Herpes simplex virus [ 12 ], and Pneumocystis pneumonia [ 13 ]. Although acute respiratory distress syndrome (ARDS) is the primary cause of mortality in COVID-19 infection, early diagnosis and treatment of serious complications such as pneumothorax [ 14 , 15 ], pneumomediastinum [ 16 , 17 ], or pulmonary embolism [ 18 ] also carry utmost importance.…”

Section: Discussionmentioning

confidence: 99%

Pneumothorax in Mechanically Ventilated Patients with COVID-19 Infection

Akdogan

Mohammed

Syeda

et al. 2021

Case Reports in Critical Care

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Data on patient-related factors associated with pneumothorax among critically ill patients with COVID-19 pneumonia is limited. Reports of spontaneous pneumothorax in patients with coronavirus disease 2019 (COVID-19) suggest that the COVID-19 infection could itself cause pneumothorax in addition to the ventilator-induced trauma among mechanically ventilated patients. Here, we report a case series of five mechanically ventilated patients with COVID-19 infection who developed pneumothorax. Consecutive cases of intubated patients in the intensive care unit with the diagnosis of COVID-19 pneumonia and pneumothorax were included. Data on their demographics, preexisting risk factors, laboratory workup, imaging findings, treatment, and survival were collected retrospectively between March and July 2020. Four out of five patients (4/5; 80%) had a bilateral pneumothorax, while one had a unilateral pneumothorax. Of the four patients with bilateral pneumothorax, three (3/4; 75%) had secondary bacterial pneumonia, two had pneumomediastinum and massive subcutaneous emphysema, and one of these two had an additional pneumoperitoneum. A surgical chest tube or pigtail catheter was placed for the management of pneumothorax. Three out of five patients with pneumothorax died (3/5; 60%), and all of them had bilateral involvement. The data from these cases suggest that pneumothorax is a potentially fatal complication of COVID-19 infection. Large prospective studies are needed to study the incidence of pneumothorax and its sequelae in patients with COVID-19 infection.

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“…Spontaneous pneumothorax can complicate pulmonary infections with Pneumocystis jirovecii, Mycobacteria, fungi or other microorganisms and the incidence varies with the frequency of these diseases in the population. 5,6 Spontaneous pneumothorax is an unusual complication in patients with COVID-19, with very few case reports, and the majority of cases occur after the 2nd week of the infection. 4,[7][8][9][10][11][12] Post-mortem examination of COVID-19 cases demonstrated alveolar exudative inflammation and damage with thickened interalveolar septa, interstitial inflammation and fibrosis, and platelet-fibrin thrombi small arterial vessels.…”

Section: Discussionmentioning

confidence: 99%

A Secondary Spontaneous Pneumothorax in a Patient with COVID-19

Alawi

Naamani

2021

Sultan Qaboos Univ Med J

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, represents an unprecedented global threat. We report a 78 - year-old man who presented to the Emergency Department at Sultan Qaboos University Hospital in June 2020 with a one-day history of right chest pain and severe breathlessness. The patient was an ex-smoker and known to have idiopathic pulmonary fibrosis (IPF) with 2 previous pneumothoraces in the left lung. On presentation, the patient was breathless with oxygen saturation of 90% on room air. Chest X-ray demonstrated bilateral lung infiltrates and right-sided pneumothorax. The patient was tested for SARS-CoV-2 and positive results were reported. The patient had a chest drain that resulted in good resolution of the pneumothorax. The patient's condition improved remarkably, and he was discharged after 17 days of hospitalization. This is the first case of pneumothorax reported in a patient infected with COVID-19 who was known to have underlying IPF. Keywords: Spontaneous Pneumothorax; Pulmonary Fibrosis; SARS Coronavirus; Oxygen, Pleurodesis, COVID-19; Pleurodesis; Steroid.

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Pneumocystis jirovecii-related spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in a liver transplant recipient: a case report

Cited by 18 publications

References 26 publications

Pneumocystis jirovecii Pneumonia: Epidemiology, Clinical Manifestation and Diagnosis

Pneumocystis jirovecii Pneumonia: Epidemiology, Clinical Manifestation and Diagnosis

Pneumothorax in Mechanically Ventilated Patients with COVID-19 Infection

A Secondary Spontaneous Pneumothorax in a Patient with COVID-19

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