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PJP Pneumothorax — SCE Infectious Diseases MCQ

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ModerateHIV MedicinePJP PneumothoraxSCE Infectious Diseases

A 30-year-old man with HIV (CD4 35 cells/µL) presents with rapidly progressive dyspnoea and hypoxia. CT chest shows bilateral ground-glass opacification with pneumatoceles. He is started on high-dose Co-trimoxazole and adjunctive Prednisolone for severe PJP. On day 3, he develops a large right-sided pneumothorax. What is the most likely cause?

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Correct answer: C — Pneumatocele rupture secondary to PJP

Pneumothorax complicating PJP is a well-recognised complication, typically resulting from rupture of subpleural pneumatoceles (thin-walled cystic spaces) that develop during PJP infection. It occurs in approximately 5–10% of severe PJP cases and is associated with worse prognosis. Management includes intercostal chest drain insertion and continuation of anti-PJP therapy. Recurrent or bilateral pneumothoraces may require surgical pleurodesis. Prolonged air leaks are common.

Reference: BHIVA 2022 – OI guidelines; BTS 2010 – Pneumothorax guidelines