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Pneumocystis carinii pleuropneumonia after aerosolized pentamidine prophylaxis
S Ewig1, J von Kempis, J Rockstroh
1Medizinische Klinik, Universität Bonn, Germany.
Abstract:
We observed an atypical Pneumocystis infection with spontaneous pneumothorax, bronchopleural fistulae, an apical cyst and Pneumocystis pleuritis after aerosolized pentamidine prophylaxis in an AIDS patient. These findings suggest a failure of pentamidine aerosol in controlling active Pneumocystis infection in peripheral pulmonary areas. A relapse of Pneumocystis carinii pneumonia (PCP) must be suspected when pneumothorax occurs during secondary prophylaxis with aerosolized pentamidine. It should always be confirmed by bronchoalveolar lavage or transbronchial or open biopsy. Cases presenting as atypical Pneumocystis pneumonia may additionally reveal extrapulmonary dissemination of Pneumocystis infection.
Insights
Atypical Pneumocystis infections can manifest with severe complications like pneumothorax, even during aerosolized pentamidine prophylaxis in AIDS patients. This suggests prophylaxis failure and the need for prompt diagnosis of Pneumocystis pneumonia relapse.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Pneumocystis pneumonia (PCP) is a significant opportunistic infection in advanced HIV/AIDS.
- Aerosolized pentamidine is a common secondary prophylaxis for PCP.
- Peripheral pulmonary infections can be challenging to diagnose and treat.
Observation:
- An AIDS patient developed an atypical Pneumocystis infection with spontaneous pneumothorax, bronchopleural fistulae, an apical cyst, and pleuritis.
- These severe pulmonary complications occurred despite receiving aerosolized pentamidine prophylaxis.
- The clinical presentation deviated from typical PCP, suggesting treatment failure.
Findings:
- Aerosolized pentamidine prophylaxis may fail to control active Pneumocystis infection in peripheral lung areas.
- Pneumothorax during secondary pentamidine prophylaxis warrants suspicion of PCP relapse.
- Atypical presentations can obscure diagnosis and may indicate extrapulmonary dissemination.
Implications:
- Clinicians should consider PCP relapse in AIDS patients presenting with pneumothorax during pentamidine prophylaxis.
- Diagnostic confirmation via bronchoalveolar lavage or biopsy is crucial.
- Early recognition and appropriate treatment are vital to manage severe Pneumocystis infections and prevent dissemination.