Pneumomediastinum in patients with AIDS: a case report and literature review

Objective: Pneumomediastinum is a rare complication of opportunistic infections in HIV-infected patients. However, the relationship between the causative pathogens and the prognosis is unclear. We report the case of a patient with AIDS presenting with community-acquired pneumonia complicated by pneumomediastinum. The cases of a further 10 HIV-infected patients with pneumomediastinum reported in the English language literature are reviewed. Methods: PubMed was searched for cases of HIV-infected patients with pneumomediastinum published in the English language literature. Results: Pneumocystis jirovecii is the most common pathogen causing pneumonia and concurrent pneumomediastinum in HIV-infected patients. Only one of the identified cases was caused by cytomegalovirus. Excluding the two cases with incomplete information, the overall mortality rate in the remaining nine cases was 55.5%. Conclusion: In HIV-infected patients, Pneumocystis jirovecii pneumonia can occasionally present as pneumomediastinum. In such cases, adequate appropriate antimicrobial therapy is needed due to the high mortality rate. (C) 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. All rights reserved.