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Article: Pneumocystis jirovecii-related spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in a liver transplant recipient: a case report

TitlePneumocystis jirovecii-related spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in a liver transplant recipient: a case report
Authors
KeywordsPneumocystis jirovecii
Pneumocystis pneumonia
Post-liver transplant
Primary biliary cirrhosis
Issue Date2019
PublisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcinfectdis/
Citation
BMC Infectious Diseases, 2019, v. 19, p. 66 How to Cite?
AbstractBackground Pneumocystis pneumonia (PCP) is a common opportunistic infection caused by Pneumocystis jirovecii. Its incidence at 2 years or more after liver transplant (LT) is < 0.1%. PCP-related spontaneous pneumothorax and/or pneumomediastinum is rare in patients without the human immunodeficiency virus, with an incidence of 0.4–4%. Case presentation A 65-year-old woman who had split-graft deceased-donor LT for primary biliary cirrhosis developed fever, dyspnea and dry coughing at 25 months after transplant. Her immunosuppressants included tacrolimus, mycophenolate mofetil, and prednisolone. PCP infection was confirmed by molecular detection of Pneumocystis jirovecii,in bronchoalveolar lavage. On day-10 trimethoprim-sulphamethoxazole, her chest X-ray showed subcutaneous emphysema bilaterally, right pneumothorax and pneumomediastinum. Computed tomography of the thorax confirmed the presence of right pneumothorax, pneumomediastinum and subcutaneous emphysema. She was managed with 7-day right-sided chest drain and a 21-day course of trimethoprim-sulphamethoxazole before discharge. Conclusion Longer period of PCP prophylaxis should be considered in patients who have a higher risk compared to general LT patients. High index of clinical suspicion, prompt diagnosis and treatment with ongoing patient reassessment to detect and exclude rare, potentially fatal but treatable complications are essential, especially when clinical deterioration has developed.
Persistent Identifierhttp://hdl.handle.net/10722/271371
ISSN
2017 Impact Factor: 2.62
2015 SCImago Journal Rankings: 1.510
PubMed Central ID

 

DC FieldValueLanguage
dc.contributor.authorShe, WH-
dc.contributor.authorChok, KSH-
dc.contributor.authorLi, IWS-
dc.contributor.authorMa, KW-
dc.contributor.authorSin, SL-
dc.contributor.authorDai, WC-
dc.contributor.authorFung, JYY-
dc.contributor.authorLo, CM-
dc.date.accessioned2019-06-24T01:08:33Z-
dc.date.available2019-06-24T01:08:33Z-
dc.date.issued2019-
dc.identifier.citationBMC Infectious Diseases, 2019, v. 19, p. 66-
dc.identifier.issn1471-2334-
dc.identifier.urihttp://hdl.handle.net/10722/271371-
dc.description.abstractBackground Pneumocystis pneumonia (PCP) is a common opportunistic infection caused by Pneumocystis jirovecii. Its incidence at 2 years or more after liver transplant (LT) is < 0.1%. PCP-related spontaneous pneumothorax and/or pneumomediastinum is rare in patients without the human immunodeficiency virus, with an incidence of 0.4–4%. Case presentation A 65-year-old woman who had split-graft deceased-donor LT for primary biliary cirrhosis developed fever, dyspnea and dry coughing at 25 months after transplant. Her immunosuppressants included tacrolimus, mycophenolate mofetil, and prednisolone. PCP infection was confirmed by molecular detection of Pneumocystis jirovecii,in bronchoalveolar lavage. On day-10 trimethoprim-sulphamethoxazole, her chest X-ray showed subcutaneous emphysema bilaterally, right pneumothorax and pneumomediastinum. Computed tomography of the thorax confirmed the presence of right pneumothorax, pneumomediastinum and subcutaneous emphysema. She was managed with 7-day right-sided chest drain and a 21-day course of trimethoprim-sulphamethoxazole before discharge. Conclusion Longer period of PCP prophylaxis should be considered in patients who have a higher risk compared to general LT patients. High index of clinical suspicion, prompt diagnosis and treatment with ongoing patient reassessment to detect and exclude rare, potentially fatal but treatable complications are essential, especially when clinical deterioration has developed.-
dc.languageeng-
dc.publisherBioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcinfectdis/-
dc.relation.ispartofBMC Infectious Diseases-
dc.rightsBMC Infectious Diseases. Copyright © BioMed Central Ltd.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectPneumocystis jirovecii-
dc.subjectPneumocystis pneumonia-
dc.subjectPost-liver transplant-
dc.subjectPrimary biliary cirrhosis-
dc.titlePneumocystis jirovecii-related spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in a liver transplant recipient: a case report-
dc.typeArticle-
dc.identifier.emailShe, WH: brianshe@hku.hk-
dc.identifier.emailChok, KSH: chok6275@hku.hk-
dc.identifier.emailLi, IWS: liws03@hku.hk-
dc.identifier.emailDai, WC: daiwc@hku.hk-
dc.identifier.emailFung, JYY: jfung@hkucc.hku.hk-
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hk-
dc.identifier.authorityChok, KSH=rp02110-
dc.identifier.authorityFung, JYY=rp00518-
dc.identifier.authorityLo, CM=rp00412-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1186/s12879-019-3723-y-
dc.identifier.pmid30658592-
dc.identifier.pmcidPMC6339407-
dc.identifier.scopuseid_2-s2.0-85060126083-
dc.identifier.hkuros297973-
dc.identifier.volume19-
dc.identifier.spage66-
dc.identifier.epage66-
dc.publisher.placeUnited Kingdom-

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