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Pneumocystis carinii pleuropneumonia after aerosolized pentamidine prophylaxis

Pleuro-Pneumonie durch Pneumocystis carinii unter Pentamidin-Inhalations-Prophylaxe

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Summary

We observed an atypicalPneumocystis infection with spontaneous pneumothorax, bronchopleural fistulae, an apical cyst andPneumocystis pleuritis after aerosolized pentamidine prophylaxis in an AIDS patient. These findings suggest a failure of pentamidine aerosol in controlling activePneumocystis infection in peripheral pulmonary areas. A relapse ofPneumocystis carinii pneumonia (PCP) must be suspected when pneumothorax occurs during secondary prophylaxis with aerosolized pentamidine. It should always be confirmed by bronchoalveolar lavage or transbronchial or open biopsy. Cases presenting as atypicalPneumocystis pneumonia may additionally reveal extrapulmonary dissemination ofPneumocystis infection.

Zusammenfassung

Wir beschreiben eine ausgedehnte atypische Pneumocystose mit Pneumothoraxbildung und Nachweis bronchopleuraler Fisteln, einer apikalen Zyste sowie einer Pneumocystis-Pleuritis bei einem AIDS-Patienten. Diese Manifestationen sind offensichtlich Ausdruck mangelhafter Suppression der Pneumocystis-Infektion durch inhaliertes Pentamidin-Aerosol in der Lungenperipherie. Jeder Spontanpneumothorax unter Pentamidin-Sekundärprophylaxe muß als verdächtig auf ein Pneumocystis-carinii-Pneumonie (PCP)-Rezidiv gelten. Diese Verdachtsdiagnose sollte den Versuch einer Diagnosesicherung durch bronchoalveoläre Lavage, transbronchiale oder offene Lungenbiopsie zur Folge haben. Bei atypischen Pneumocystis-Pneumonien muß mit dem Vorliegen einer extrapulmonalen Dissemination gerechnet werden.

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Authors and Affiliations

  1. Medizinische Klinik der Universität Bonn, Sigmund-Freud-Str. 25, W-5300, Bonn 1, Germany

    S. Ewig,  J. von Kempis,  J. Rockstroh &  D. Niese

  2. Radiologische Klinik der Universität Bonn, Sigmund-Freud-Str. 25, W-5300, Bonn 1, Germany

    A. Steudel

  3. Pathologisches Institut der Universität Bonn, Sigmund-Freud-Str. 25, W-5300, Bonn 1, Germany

    J. Vogel

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  1. S. Ewig
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  2. J. von Kempis
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  3. J. Rockstroh
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  4. D. Niese
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  5. A. Steudel
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  6. J. Vogel
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Ewig, S., von Kempis, J., Rockstroh, J. et al. Pneumocystis carinii pleuropneumonia after aerosolized pentamidine prophylaxis. Infection 19, 442–444 (1991). https://doi.org/10.1007/BF01726460

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  • DOI: https://doi.org/10.1007/BF01726460

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