Bilateral spontaneous pneumothorax in tuberculosis and HIV patient: A case report

INTRODUCTION: Bilateral secondary spontaneous pneumothorax due to tuberculosis and human immunodeficiency virus (TB-HIV) infection is a rare case which has a poor prognosis and high-risk mortality. CASE PRESENTATION: An Indonesian male, 31 years old, complained of shortness of breath, chest pain, and weight loss (15 kg for 2 months). He has a history of HIV and has been only on ARVs for 3 months since being diagnosed. He, his sister, and his mother had all experienced tuberculous lymphadenitis. The patient appears weak, dyspnea, visual analogue scale (VAS) of 5, blood pressure (BP) of 92/64 mmHg, heart rate (HR) of 112 ×/min, temperature of 37.7 °C, respiratory rate (RR) of 32 ×/min, oxygen saturation (SpO2) of 98 % (simple mask of 8 L/min). On inspection and fremitus, the development of left lung expansion was delayed. Percussion sound of left lung was hypersonor and decreased lung sounds on auscultation. A chest X-ray revealed pneumothorax sinistra. The patient underwent needle thoracocentesis with chest tube insertion and water seal drainage (WSD). During the continuation phase, the patient also took anti-retroviral (ARV) and anti-tuberculosis drug (ATD). The patient had improved but a few days later developed a pneumothorax dextra and received treatment. The patient only survived for 2 days afterwards and died caused by hypovolemic shock. DISCUSSION: Management of pneumothorax in TB-HIV patients shows only temporary improvement but poor prognosis. Adherence of HIV patients to ARVs minimizes the risk of infected with Mycobacterium tuberculosis in endemic areas. CONCLUSION: HIV patients are anticipated to remain committed to their treatment regimens in order to reduce the occurrence of pneumothorax induced by TB-HIV in endemic areas.