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BILATERAL PNEUMOTHORAX AND ACUTE RESPIRATORY FAILURE IN AN ADULT DIAGNOSED WITH PCP

Spontaneous pneumothorax in Pneumocystis jirovecii pneumonia may be a common complication (1) but is a poor prognostic sign (2), especially if with occurrence of acute respiratory failure. However, in the Philippines, especially as a case of persistent bilateral pneumothorax, there is paucity of resources on the topic. A 36-year-old man consulted at the Emergency Room because of dyspnoea. He has been having dyspnoea for three weeks, associated with productive cough with yellowish sputum, but without fever. He was admitted at another institution and treated as a case of Community-Acquired Pneumonia. He was discharged improved after five days of intravenous antibiotics. However, at home, his dyspnoea was intermittent but was occurring more frequently, with longer episodes of breathlessness, up to a point that he had bluish discoloration of his lips. He was then admitted, but acutely developed progressive and severe dyspnoea. Non-invasive ventilation (NIV) was utilized using Bilevel Positive Airway Pressure Ventilation, but later on failed, and was converted into Endotracheal Intubation. On succeeding days, his breathlessness improved, but still with desaturation. However, on one morning, he had sudden episode of severe dyspnoea. Chest radiograph confirmed the presence of pneumothorax on his right lung, and later on developed pneumothorax on the left. Chest tube thoracostomy was initially done. However, the pneumothorax persisted and Video-Assisted Thoracoscopic Surgery (VATS) with Bullectomy and Mechanical Pleurodesis were done. The patient’s condition improved over the succeeding days and was discharged. This case exemplifies management of spontaneous pneumothorax in a PCP-diagnosed patient. Although there were several issues raised, including deliberations regarding employment of NIV over Endotracheal Intubation and the significance and efficacy of pleurodesis in PCP pneumothorax, resolution of this case points to the success of intubation and surgical pleurodesis.