de la Fuente Aguado J

Neumotórax en pacientes infectados por el virus de inmunodeficiencia humana

OBJECTIVE: Patients with HIV who develop pneumothorax have been previously described. Pneumocystis carinii pneumonia (PCN) is the leading cause of this complication, but infection by other pulmonary microorganism, inhaled pentamidine therapy and lung invasive manoeuvres have also been associated with pneumothorax in HIV infected patients. METHOD: We review the most relevant clinical aspects of pneumothorax in HIV-infected persons, gathered in our hospital along eight years, before HAART therapy was started. During this time, 97 patients with PCN were diagnosed and 148 patients received prophylaxis with inhaled pentamidine. Only 14 episodes of pneumothorax in 13 patients, were recorded. In ten occasions pneumothorax was related to pulmonary invasive manoeuvres, pulmonary infections were found in three and was considered spontaneous in one. The pulmonary invasive manoeuvres were: subclavia vein catheterisation in six cases (one of them was diagnosed of proved PCN and the other has pneumococcal pneumonia); transbronchial biopsy in one patient (also with proved PCN), knife chest trauma in two cases and after fine needle aspiration of an axillary lymph node in one patient. RESULTS: The pulmonary infections associated with pneumothorax in three patients were: proved PCN (this patient was the only one in the group with inhaled pentamidine prophylaxis who developed pneumothorax), active pulmonary infection by mycobacterium tuberculosis and Pseudomonas aeruginosa pneumonia. A drainage chest tube was placed in 12 patients with complete resolution in nine. In the other two patients pleurodesis was necessary and surgical repair was carried out in the other one (who had pulmonary tuberculosis). During the follow up six patients died (median time to death: 7 months). Among patients who died, five had pulmonary infections when the pneumothorax was diagnosed: PCN in three cases, pulmonary tuberculosis and pseudomonas pneumonia in the other two; all of them with less than 100 CD4 lymphocytes. CONCLUSIONS: Pneumothorax is frequent in HIV-infected patients with PCN, but other lung infections and, above all pulmonary invasive manoeuvres, can cause this complication. In our experience, HIV-infected patients who develop pneumothorax have a bad prognosis.

Post-thrombotic syndrome.

Figura 2 Varón de 62 años que consulta por un aumento del perímetro del miembro inferior izquierdo, desde el tobillo hasta la ingle, no doloroso, con edema sin fóvea (fig. 1). Desde hacía 3 meses presentaba una lesión irregular en la región externa del muslo izquierdo, eritemato-violácea, exofítica, de consistencia dura, que había aumentado progresivamente su tamaño (fig. 2). Entre sus antecedentes destacaban una hipertensión arterial, enfermedad pulmonar obstructiva crónica grave, con oxigenoterapia domiciliaria, y una hemiplejía izquierda residual por un ictus hemorrágico. Un año antes había ingresado por una trombosis venosa profunda, con oclusión completa de las venas poplítea y femoral