Sripavatakul Kwanreuthai, Foocharoen Chingching
Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
J Med Case Rep. 2011 Jul 13;5:309. doi: 10.1186/1752-1947-5-309.
Spontaneous pneumothorax is usually found in people with systemic sclerosis who have extensive pulmonary fibrosis with enlarged sub-pleural blebs. We report a case of spontaneous pneumothorax caused by cryptococcal pneumonia in a patient with systemic sclerosis with minimal sub-pleural emphysema.
A 49-year-old Thai man with underlying limited cutaneous systemic sclerosis presented with acute low-grade fever, progressive dyspnea and right pleuritic chest pain for five days. Our patient had pulmonary fibrosis with bronchiectasis of both lower lungs related to this underlying disease. He received only low-dose steroid therapy, without any immunosuppressant. A chest radiograph revealed right lung pneumothorax with cloudy yellow color pleural fluid. Cryptococcal pneumonia was diagnosed by positive identification of the cryptococcal antigen in the serum and pleural fluid. His symptoms improved after intercostal drainage and fluconazole therapy.
Infection can exacerbate symptoms in patients with systemic sclerosis with sub-pleural emphysema, thereby triggering a spontaneous pneumothorax. Pleural fluid--present but not initially seen because of the pneumothorax--could be a clue to a pre-existing pulmonary infection.
特发性气胸通常见于患有广泛肺纤维化并伴有胸膜下大疱增大的系统性硬化症患者。我们报告一例由隐球菌性肺炎引起的特发性气胸病例，该患者患有系统性硬化症，胸膜下肺气肿轻微。
一名49岁的泰国男性，患有潜在的局限性皮肤系统性硬化症，出现急性低热、进行性呼吸困难和右胸痛五天。我们的患者因这种基础疾病患有双下肺肺纤维化并伴有支气管扩张。他仅接受低剂量类固醇治疗，未使用任何免疫抑制剂。胸部X光片显示右肺气胸，伴有浑浊的黄色胸腔积液。通过血清和胸腔积液中隐球菌抗原的阳性鉴定诊断为隐球菌性肺炎。经肋间引流和氟康唑治疗后，他的症状有所改善。
感染可使患有胸膜下肺气肿的系统性硬化症患者的症状加重，从而引发特发性气胸。胸腔积液——因气胸最初未被发现——可能是先前存在肺部感染的线索。
