Unmasking HIV: Bilateral Spontaneous Pneumothorax Following COVID-19 Pneumonia in an Immunocompromised Patient
Recommended Citation
Bhui P, Chalasani P, Nagaraja T, Mansour M, Sabbaq M. Unmasking HIV: Bilateral Spontaneous Pneumothorax Following COVID-19 Pneumonia in an Immunocompromised Patient. Am J Respir Crit Care Med 2025; 211:A3948.
Document Type
Conference Proceeding
Publication Date
5-20-2025
Publication Title
Am J Respir Crit Care Med
Abstract
Introduction:Spontaneous pneumothorax (SP) is a recognized complication in Human Immunodeficiency virus (HIV) patients, associated with Pneumocystis jirovecii pneumonia (PCP). Recent studies link COVID-19 with SP, potentially due to cystic and fibrotic lung changes exacerbated by mechanical ventilation and prolonged coughing. This case highlights a 30-year-old female who developed bilateral SP following COVID-19 infection and was subsequently diagnosed with HIV. Case Description:A 30-year-old female with a history of asthma, type 2 diabetes mellitus, and nicotine vaping presented with worsening shortness of breath and pleuritic chest pain after recent COVID-19 treatment with remdesivir and dexamethasone. On presentation, she was hemodynamically stable but severely hypoxic, with an SpO₂ of 64% on 2L oxygen via nasal cannula. Laboratory findings showed leukocytosis and hyperglycemia while electrolytes, lactate, troponins, and BNP were within normal limits. A computed tomography angiogram (CTA) ruled out pulmonary embolism but revealed diffuse ground-glass and reticular opacities throughout both lungs, mildly progressed from previous imaging. Her acute hypoxic respiratory failure was multifactorial, attributed to post-COVID-19 organizing pneumonia versus vaping-related lung injury, requiring prolonged noninvasive ventilatory support. Persistent hypoxemia and recurrent respiratory distress complicated weaning from oxygen. Bilateral SP developed during her hospital stay, requiring chest tube placement. Given concerns for PCP, empiric trimethoprim-sulfamethoxazole was initiated, with vancomycin and cefepime until bronchoalveolar lavage cultures resulted. Methylprednisolone, guaifenesin and breathing treatments were administered. Extensive infectious workup, including fungal cultures, beta-D-glucan, galactomannan, and HIV testing, revealed HIV positivity with a CD4 count of 10. Despite intensive treatment, patient's condition worsened, leading to her death. Discussion:COVID-19-related complications are more challenging in undiagnosed immunosuppressed patients due to prolonged viral shedding, secondary infections, and atypical inflammation. Immune dysregulation can mask typical symptoms, leading to delayed or atypical presentations like organizing pneumonia and pneumothorax. Underlying immunodeficiency, as in this case with a low CD4 count, complicates diagnosis since infections like P. jirovecii may mimic COVID-19-related pulmonary complications. This often necessitates prolonged ventilatory support, further increasing complication risk. Early recognition of immunosuppression enables targeted therapies and optimized supportive care, ultimately reducing morbidity and mortality by managing these complex, interwoven complications effectively. Conclusion:This case illustrates the complex interaction of COVID-19, vaping-related complications, and immunosuppression, necessitating multidisciplinary management. Early recognition of hidden immunosuppressive conditions enables tailored interventions, optimizing patient outcomes. This case underscores the importance of thorough diagnostic evaluation in patients with atypical presentations and reinforces the need for heightened clinical vigilance in managing respiratory complications in those with potential immunodeficiency.
Volume
211
First Page
A3948
