Bilateral Spontaneous Pneumothorax in a COVID-19 and HIV-Positive Patient: A Case Report

A Case of Bilateral Pneumothorax With COVID-19 Infection

Bilateral spontaneous pneumothorax is a serious complication of coronavirus disease 2019 (COVID-19). The incidence of any spontaneous pneumothorax in patients with the aforementioned viral infection when hospitalized is about 1%. Treatment can involve management such as oxygen support, tube thoracostomy, pleurodesis, or even invasive surgery. The associated mortality with this complication is about 33% to 52%. We present a case of bilateral pneumothorax in a patient diagnosed with COVID-19 without any history of smoking or underlying lung disease. Careful vigilance and close monitoring of this serious complication are mandatory in inpatients.

Spontaneous pneumothorax and COVID-19: Precipitants to a complex HIV-AIDS diagnosis

A 48-year-old male presented with spontaneous pneumothorax requiring chest tube placement in the setting of COVID-19 infection. CT chest revealed bilateral ground-glass opacities and multiple, large, gas-filled, cavitary lesions in the lungs bilaterally. These imaging findings led to an initial HIV diagnosis with the patient presenting at a CD4+ count of <32 cells/µL. He was found to additionally have infections with Mycobacterium kansasii, cytomegalovirus, Pneumocystis jirovecii, and Candida albicans. After developing worsening hypoxic respiratory failure, he developed additional pneumothoraces bilaterally, requiring repeated chest tube placement. He was treated with antimicrobial therapy for his underlying infections and subsequently started on combined antiretroviral therapy.