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

BACKGROUND: Pneumocystis pneumonia (PCP) is a common opportunistic infection caused by Pneumocystis jirovecii. Its incidence at 2 years or more after liver transplant (LT) is < 0.1%. PCP-related spontaneous pneumothorax and/or pneumomediastinum is rare in patients without the human immunodeficiency virus, with an incidence of 0.4-4%. CASE PRESENTATION: A 65-year-old woman who had split-graft deceased-donor LT for primary biliary cirrhosis developed fever, dyspnea and dry coughing at 25 months after transplant. Her immunosuppressants included tacrolimus, mycophenolate mofetil, and prednisolone. PCP infection was confirmed by molecular detection of Pneumocystis jirovecii,in bronchoalveolar lavage. On day-10 trimethoprim-sulphamethoxazole, her chest X-ray showed subcutaneous emphysema bilaterally, right pneumothorax and pneumomediastinum. Computed tomography of the thorax confirmed the presence of right pneumothorax, pneumomediastinum and subcutaneous emphysema. She was managed with 7-day right-sided chest drain and a 21-day course of trimethoprim-sulphamethoxazole before discharge. CONCLUSION: Longer period of PCP prophylaxis should be considered in patients who have a higher risk compared to general LT patients. High index of clinical suspicion, prompt diagnosis and treatment with ongoing patient reassessment to detect and exclude rare, potentially fatal but treatable complications are essential, especially when clinical deterioration has developed.

Virus respiratorio sincitial: no solo bronquiolitis en lactantes / Respiratory syncytial virus: not only bronchiolitis in infants

El neumomediastino espontáneo se define como la presencia de aire dentro del mediastino. Se origina generalmente por una fuga de aire por aumento de presión en el alveolo. La incidencia en la edad pediátrica se encuentra entre 1/8000 y 1/15 000, con dos picos de edad: menores de cuatro años y de entre 13 a 17 años. En el primer grupo suele asociarse a una infección del tracto respiratorio, una crisis asmática o por aspiración de cuerpo extraño, mientras que en el segundo suele originarse tras actividad física intensa. Se ha descrito la implicación de virus como influenza o bocavirus en la fisiopatología de esta entidad, pero hasta el momento muy pocos casos se han descrito en relación con el virus respiratorio sincitial. La clínica más frecuente es dolor torácico junto con disnea y enfisema subcutáneo como signo característico. El diagnóstico en casi todos los casos lo dará la radiografía de tórax. El manejo dependerá del grado de afectación y su repercusión, por lo que variará desde observación hasta ingreso en una Unidad de Cuidados Intensivos. El tratamiento será de soporte y el de las complicaciones asociadas, no se suelen dar recurrencias y el pronóstico suele ser bueno en la mayor parte de los casos

Spontaneous pneumomediastinum is defined as free air or gas contained within the mediastinum. It originates from the rupture of alveolar space because of high pressures. The incidence of spontaneous pneumomediastinum in pediatrics is between 1/8000 to 1/15 000 with two age peaks; under 4 years old and between 13 to 17 years old. First group is characterized by being secondarily accompanied by an infection of the respiratory tract, asthmatic exacerbation or foreign body aspiration while the second one usually originates after intense physical activity. Influenza or bocavirus have been related with the pathology of this entity, but few cases have been written in relation to respiratory syncytial virus. The most common symptoms are chest pain and dyspnea with subcutaneous emphysema as a characteristic sign. Diagnosis in almost all cases will be given by a chest X-ray. Management will depend on the degree of involvement and its repercussion, which will spread from observation to admission to the ICU. Conservative therapy and treatment of associated complications are usually sufficient, there are few recurrences and the prognosis is good in most of cases

Pneumocystis carinii infection with severe pneumomediastinum and lymph node involvement in a Whippet mixed-breed dog.

A 3.5-y-old Whippet mixed-breed dog was presented with a history of respiratory distress, exercise intolerance, and generalized demodicosis. Hematologic alterations included marked leukocytosis and neutrophilia. Radiographic examination showed a diffuse interstitial and mild peripheral alveolar lung pattern and pneumomediastinum. Because the cytologic examination of the bronchoalveolar aspirate was not diagnostic and a persistent perforation of the upper respiratory tract could not be ruled out, the dog was submitted to thoracoscopy, and subsequently the left cranial lung lobe as well as mediastinal and sternal lymph nodes were resected. Pulmonary pneumocystosis with spread to the thoracic lymph nodes was suspected after histologic investigation of lung and lymph nodes, which was confirmed by in situ hybridization, PCR, and subsequent Sanger sequencing. We document a rare, simultaneous occurrence of severe pulmonary and thoracic lymph node pneumocystosis with spontaneous pneumomediastinum in a dog. Definitive diagnosis was achieved through the use of Grocott methenamine silver staining, in situ hybridization, and PCR.

Pneumomediastinum as a complication of critical pertussis.

BACKGROUND AND AIMS: Pertussis is a common and potentially serious disease affecting mainly infants and young children. In its non-classic presentation, pertussis can be clinically indistinguishable from other respiratory illnesses. Pertussis today often remains underdiagnosed in adults. Our aims was to report a complicated cases of pertussis. RESULTS: A case of serologically confirmed pertussis occurred in an 18-year-old man presenting with pneumomediastinum, subcutaneous emphysema in the neck and chest, and persistent attacks of coughing with apnea that required treatment in the intensive care unit. CONCLUSION: Pneumomediastinum and subcutaneous emphysema have never been described in adult patients with pertussis. Physicians should be aware that patients presenting with persistent cough and pneumomediastinum may have pertussis and include this in their differential diagnosis.

Group A Streptococcus causing descending necrotizing mediastinitis: report of a case and literature review.

BACKGROUND: Descending necrotizing mediastinitis is a serious condition with few cases reported in the literature. Surgical treatment is controversial and may include wound exploration, local drainage, and even mediastinal debridement approached by thoracotomy. METHODS: Description of a case of descending mediastinitis caused by group A Streptococcus as a complication of thyroidectomy. RESULTS: Aggressive debridement was required for source control and treatment of septic shock. CONCLUSION: Post-thyroidectomy descending necrotizing mediastinitis is a rare and dangerous infection. It should be treated aggressively with appropriate cervical and mediastinal drainage combined with optimum medical care.

Newly formed cystic lesions for the development of pneumomediastinum in Pneumocystis jirovecii pneumonia.

BACKGROUND: Pneumocystis jirovecii, formerly named Pneumocystis carinii, is one of the most common opportunistic infections in human immunodeficiency virus (HIV)-infected patients. CASE PRESENTATIONS: We encountered two cases of spontaneous pneumomediastinum with subcutaneous emphysema in HIV-infected patients being treated for Pneumocystis jirovecii pneumonia with trimethoprim/sulfamethoxazole. CONCLUSION: Clinicians should be aware that cystic lesions and bronchiectasis can develop in spite of trimethoprim/sulfamethoxazole treatment for P. jirovecii pneumonia. The newly formed bronchiectasis and cyst formation that were noted in follow up high resolution computed tomography (HRCT) but were not visible on HRCT at admission could be risk factors for the development of pneumothorax or pneumomediastinum with subcutaneous emphysema in HIV-patients.

Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia.

We present a 3-year-old child with severe extensive Mycoplasma pneumoniae pneumonia complicated with pneumomediastinum and pneumothorax. Pneumothorax and pneumomediastinum have only exceptionally been described in mild cases of the disease. The radiological findings, differential diagnosis and clinical course are discussed.

Pneumomediastinum complicating childhood acute lymphoblastic leukaemia.

A case of pneumomediastinum that developed in a 10 year old girl receiving induction chemotherapy for acute lymphoblastic leukemia is reported. Three factors were identified that may have been associated with this complication: the patient suffered recurrent vomiting during her induction chemotherapy; she had travelled by air the day before the pneumo mediastinum was diagnosed; and was septic with Enterobacter at time of diagnosis. The pneumomediastinum resolved over 2 weeks without specific treatment and without further complications.

Asymptomatic amniotic fluid invasion with Candida albicans in preterm premature rupture of membranes. Implications for obstetric and neonatal management.

A case of asymptomatic intraamniotic infection with Candida albicans in a woman presenting with preterm premature rupture of membranes is reported. Active prenatal diagnostic procedures and prompt and accurate neonatal treatment (Amphotericin B) improved significantly the usually poor outcome of these pregnancies.