Li Jun-Chen, Nie Gang, Dai Hai-Feng
Department of Internal Medicine, University-Town Hospital of Chongqing Medical University, Chongqing 400000, China.
Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China.
Curr HIV Res. 2022;20(6):479-484. doi: 10.2174/1570162X20666220829143802.
Acquired immunodeficiency syndrome is a chronic infectious disease with high mortality and is caused by the Human Immunodeficiency Virus (HIV). Pneumonia caused by HIV is common, but it rarely causes spontaneous mediastinal and subcutaneous emphysema.
A 21-year-old man with severe pneumonia was hospitalized owing to dyspnea that had been persisting for 1 day; blood test results confirmed HIV infection. Initial chest Computed Tomography (CT) did not reveal mediastinal or subcutaneous emphysema. However, after 21 days of treatment, the patient experienced discomfort in the neck region and experienced the feeling of snowflakes on applying pressure. Chest CT showed mediastinal and subcutaneous emphysema, located in the bilateral cervical roots, anterior upper chest wall, left axillary chest wall, mediastinum, and other parts. Metagenomic Next Generation Sequencing (mNGS) of the sputum and blood samples suggested multiple pathogenic infections. Antiinfection treatment was initiated, and changes in the patient's condition were monitored. The patient's subcutaneous emphysema improved during the follow-up.
In HIV-infected patients with sudden mediastinal and subcutaneous emphysema, mNGS can be used to determine the etiological agent during symptomatic treatment. Targeted antipathogen therapy is helpful in improving the condition of patients with subcutaneous emphysema.
获得性免疫缺陷综合征是一种死亡率高的慢性传染病，由人类免疫缺陷病毒（HIV）引起。HIV 所致肺炎较为常见，但很少引起自发性纵隔和皮下气肿。
一名 21 岁男性因持续 1 天的呼吸困难伴重症肺炎入院；血液检查结果证实感染 HIV。初始胸部计算机断层扫描（CT）未显示纵隔或皮下气肿。然而，经过 21 天的治疗后，患者颈部出现不适，按压时有雪花感。胸部 CT 显示纵隔和皮下气肿，位于双侧颈根部、前胸壁上部、左腋胸壁、纵隔等部位。痰液和血液样本的宏基因组下一代测序（mNGS）提示多种病原体感染。开始抗感染治疗，并监测患者病情变化。随访期间患者的皮下气肿有所改善。
在 HIV 感染且突发纵隔和皮下气肿的患者中，对症治疗期间 mNGS 可用于确定病原体。针对性抗病原体治疗有助于改善皮下气肿患者的病情。
