Pneumomediastinum and Subcutaneous Emphysema as Initial Presentations of Pneumocystis Jirovecii Pneumonia in a Newly Diagnosed HIV-Infected Patient: A Case Report.

Pneumocystis jirovecii pneumonia (PJP) is a life-threatening opportunistic infection that primarily affects immunocompromised individuals, particularly those with acquired immunodeficiency syndrome caused by human immunodeficiency virus (HIV). The clinical presentation of PJP can be atypical, with symptoms such as spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema, complicating diagnosis. In this report, we present a case of a 31-year-old male pharmacist with newly diagnosed HIV and PJP, who presented with persistent cough, dyspnea, intermittent fever, and subcutaneous emphysema. Chest X-ray and CT scans revealed bilateral ground-glass opacities, pneumomediastinum, and subcutaneous emphysema. The patient was diagnosed with HIV and PJP based on clinical findings and laboratory tests. Treatment with levofloxacin, penicillin, Caspofungin, and antiretroviral therapy led to significant improvement. This case highlights the importance of early diagnosis and the need for heightened clinical awareness of PJP in HIV-positive patients presenting with respiratory symptoms, particularly when imaging reveals atypical features.