Sherman et al reported three cases of spontaneous pneumothorax associated with PCP and observed persistent bronchopleural fistulas in two of their three patients. Furthermore, tension pneumothorax has been described in association with PCP In addition to the high rate of resolution of pneumothorax observed in this study, it is also noteworthy that in six of eight patients (75 precent) lung reexpansion occurred with conservative therapy (no chest tube placement). The relatively young age of these patients, their good lung mechanics, and their ability to tolerate a hemodynamic insult may have allowed for the successful reexpansion without chest tube placement. Since bilateral pneumothorax can occur in AIDS patients with PCP (patients 1, 2, and 5 in this study), as well as tension pneumothorax, conservative management is not appropriate for all patients. Indeed, all patients receiving positive pressure ventilation in the setting of pneumothorax should probably undergo tube thoracostomy.
In summary, the incidence of pneumothorax in AIDS patients with PCP is greater than in AIDS patients without PCP The mechanism of how PCP results in the formation of pneumothorax is unknown. It may be that AIDS patients with PCP and pneumothorax will respond to conservative management, especially when they do not require positive pressure ventilation.
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