Pneumothorax as a Prelude: Unveiling Concurrent HIV and Pneumocystis jirovecii Pneumonia in a Diagnostic Journey

TL;DR

A young man with no known risk factors was diagnosed with HIV and PCP after presenting with lung symptoms and pneumothorax.

Contribution

Highlights PCP diagnosis in an immunocompetent patient with no prior HIV risk factors.

Findings

PCP was diagnosed in a 25-year-old male with no known immunocompromising conditions.

HIV was detected through serology, and PCR confirmed Pneumocystis jirovecii infection.

Radiologic findings included pneumothorax, ground-glass opacities, and cystic lung lesions.

Abstract

Pneumocystis jirovecii pneumonia (PCP) is a life-threatening condition found in immunocompromised individuals, especially in human immunodeficiency virus (HIV) positive patients. Here, we report a case of PCP in a presumably immunocompetent 25-year-old male patient who presented with a one-month history of chest pain, dyspnea, and a nonproductive cough with recent development of night sweats. The patient recently immigrated to the United States without any known medical or family history. A chest radiograph revealed moderate pneumothorax for which a chest tube was placed. A chest computed tomography (CT) scan revealed diffuse lung disease with multiple thin- and thick-walled cystic lesions on a background of diffuse ground-glass opacities. Based on these radiologic findings and subsequent positive HIV serology, there was a high suspicion of PCP. Bronchoalveolar lavage was performed, and PCR for Pneumocystis jirovecii was positive. Appropriate treatment was initiated, and the patient recovered well. Through this report, we aim to highlight the importance of recognizing the various clinical and radiologic findings of PCP even in patients with no overt risk factors. Prompt and targeted treatment could mitigate morbidity and mortality associated with this opportunistic pathogen.

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