Thoracotomy as treatment for pneumothorax associated with pneumocystic carinii pneumonia in a patient with hemophilia A and the acquired immunodeficiency syndrome

: Pneumocystis carinii pneumonia is the most common respiratory infection in patients with the acquired immunodeficiency syndrome, and inhalation of pentamidine aerosol is currently used for secondary prophylaxis. A 16-year-old patient with hemophilia A and the acquired immunodeficiency syndrome had a spontaneous pneumothorax during inhalation of pentamidine aerosol for secondary prophylaxis of Pneumocystis carinii pneumonia. Tube thoracostomy and pleurodesis were done without success. Thoracotomy was done 27 days after admission. The patient tolerated the procedure well, and the postoperative course was uneventful. Grocott staining of tissue from the bronchopleural fistula revealed Pneumocystis carinii, which suggests that the pentamidine aerosol failed to control and active Pneumocystis infection in peripheral lung zones.