G Jithesh, Narayanan Swetha, Kumar Sahil, Banjade Madhav, Bairwa Mukesh
Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Hospital Medicine and Critical Care, Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Cureus. 2024 Apr 17;16(4):e58440. doi: 10.7759/cureus.58440. eCollection 2024 Apr.
A trio of spontaneous pneumomediastinum, pneumopericardium, and pneumothorax is a highly unusual presentation. The majority of reported cases are due to trauma, while the remaining cases are iatrogenic. Among infections, this trio has so far been reported in COVID-19 pneumonia and pneumocystis pneumonia in HIV-positive patients. There are case reports on pneumothorax and pneumomediastinum in tuberculosis, but the trio is not reported. Here, we present a case of a recently diagnosed HIV-positive patient with complaints of cough and shortness of breath whose initial workup was negative for Mycobacterium. The patient was, however, started on antitubercular drugs based on clinical radiological evidence. He developed spontaneous pneumothorax, pneumomediastinum, and pneumopericardium, and repeat bronchoalveolar lavage (BAL) came positive for Mycobacterium. The patient, however, could not be revived and succumbed to obstructive and septic shock.
自发性纵隔气肿、心包积气和气胸同时出现的情况极为罕见。大多数报告病例是由创伤引起的，其余病例则是医源性的。在感染性疾病中，迄今为止，这种三联征已在新冠肺炎和HIV阳性患者的肺孢子菌肺炎中被报道。有关于肺结核患者气胸和纵隔气肿的病例报告，但三联征未见报道。在此，我们报告一例近期诊断为HIV阳性的患者，主诉咳嗽和气短，其初始检查未发现结核分枝杆菌。然而，基于临床影像学证据，该患者开始接受抗结核药物治疗。他出现了自发性气胸、纵隔气肿和心包积气，再次进行支气管肺泡灌洗（BAL）时结核分枝杆菌呈阳性。然而，该患者未能复苏，最终死于梗阻性和感染性休克。
