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

Cheng, Wan Ling; Ko, Wen Chien; Lee, Nan Yao; Chang, Chia Ming; Lee, Ching Chi; Li, Ming Chi; Li, Chia Wen

doi:10.1016/j.ijid.2013.12.009

Cited by 14 publications

(12 citation statements)

References 22 publications

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“…On the basis of aging lung changes, broncho-pulmonary infection is also a risk factor for we have found several papers that have also reported pneumomediastinum in conjunction with other pulmonary infections. Pneumomediastinum can be found in patients with AIDS presenting with community-acquired pneumonia due to Pneumocystis jirovecii [ 7 ]. Separately, Hasegawa et al[ 8 ] showed two children infected with the flu virus of H1N1 who developed SPM.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumomediastinum in an elderly COVID-19 patient: A case report

Kong

Gao

et al. 2020

WJCC

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BACKGROUND Spontaneous pneumomediastinum (SPM) is more common in young adults, usually caused by external factors like trauma. It causes symptoms such as chest pain or dyspnea, but it is rare to see elderly patients who develop SPM. Here we report the case of an elderly patient diagnosed with coronavirus disease 2019 (COVID-19) who neither got mechanical ventilation nor had chest trauma but were found to develop SPM for unknown reason. CASE SUMMARY A 62-year-old man complained of a 14-d history of fever accompanied by dry cough, shortness of breath, wheezing, myalgia, nausea, and vomiting. Real-time fluorescence polymerase chain reaction confirmed the diagnosis of COVID-19. The patient was treated with supplementary oxygen by nasal cannula and gamma globulin. Other symptomatic treatments included antibacterial and antiviral treatments. On day 4 of hospitalization, he reported sudden onset of dyspnea. On day 6, he was somnolent. On day 12, the patient reported worsening right-sided chest pain which eventually progressed to bilateral chest pain. He was diagnosed with SPM, with no clear trigger found. Conservative treatment was administrated. During follow-up, the pneumomediastinum had resolved and the patient recovered without other complications. CONCLUSION We presume that aging lung changes and bronchopulmonary infection play an important part in the onset of SPM in COVID-19, but severe acute respiratory syndrome may represent a separate pathophysiologic mechanism for pneumomediastinum. Although the incidence of SPM in elderly patients is low, clinicians should be alert to the possibility of SPM in those infected with severe acute respiratory syndrome coronavirus 2 for life-threatening complications such as cardiorespiratory arrest may occur.

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Section: Discussionmentioning

confidence: 99%

Spontaneous pneumomediastinum in an elderly COVID-19 patient: A case report

Kong

Gao

et al. 2020

WJCC

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“…The prevalence of pneumomediastinum in PCP is thought to be 0.4-3.3%. 4 The abrupt change in transalveolar pressure that leads to spontaneous pneumomediastinum was first described in 1939 by Macklin who proposed that an abrupt change in pressure due to coughing or straining could cause alveolar rupture and tracking of air along the interstitial sheaths toward the mediastinum. 5 In general, alveolar rupture is reported to be the cause of spontaneous pneumomediastinum in over 95% of cases.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous Emphysema: A Case Report of an Atypical Manifestation of PCP in an HIV Patient

Kotler¹,

Johnson²

2017

TMF

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“…Pneumomediastinum is the presence of extra-alveolar air in the mediastinum, which is believed to arise from free air leaking from ruptured alveoli. It was described as an uncommon complication of opportunistic infections in HIV-infected patients [ 13 , 14 ]. However, 24.4 % patients in our study developed pneumomediastinum.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for severe Pneumocystis jiroveci pneumonia of non-HIV patients in intensive care unit: a bicentric retrospective study

et al. 2016

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BackgroundPneumocystis jiroveci pneumonia (PJP) in non-HIV patients is still a challenge for intensivists. The aim of our study was to evaluate mortality predictors of PJP patients requiring Intensive care unit (ICU) admission.MethodsRetrospectively review medical records of patients with diagnosis of PJP admitted to four ICUs of two academic medical centers from October 2012 to October 2015.ResultsEighty-two patients were enrolled in the study. Overall hospital mortality was 75.6 %. Compared with survivors, the non-survivors had older age (55 ± 16 vs. 45 ± 17, p = 0.014), higher APACHE II score (20 ± 5 vs. 17 ± 5, p = 0.01), lower white blood cell count (7.68 ± 3.44 vs. 10.48 ± 4.62, p = 0.005), less fever (80.6%vs. 100 %, p = 0.033), more hypotension (58.1 % vs. 20 %, p = 0.003), more pneumomediastinum (29 % vs. 5 %, p = 0.027). Logistic regression analysis demonstrated that age [odds ratio (OR)1.051; 95 % CI 1.007-1.097; p = 0.022], white blood cell count [OR 0.802; 95 % CI 0.670-0.960; p = 0.016], and pneumomediastinum [OR 16.514; 95 % CI 1.330-205.027; p = 0.029] were independently associated with hospital mortality.ConclusionsMortality rate for non-HIV PJP patients requiring ICU admission was still high. Poor prognostic factors included age, white blood cell count and pneumomediastinum.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1855-x) contains supplementary material, which is available to authorized users.

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

Abstract: In HIV-infected patients, Pneumocystis jirovecii pneumonia can occasionally present as pneumomediastinum. In such cases, adequate appropriate antimicrobial therapy is needed due to the high mortality rate.

Cited by 14 publications

References 22 publications

Spontaneous pneumomediastinum in an elderly COVID-19 patient: A case report

Spontaneous pneumomediastinum in an elderly COVID-19 patient: A case report

Subcutaneous Emphysema: A Case Report of an Atypical Manifestation of PCP in an HIV Patient

Prognostic factors for severe Pneumocystis jiroveci pneumonia of non-HIV patients in intensive care unit: a bicentric retrospective study

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