[Unusual presentation of bilateral bullous Pneumocystis jiroveci pneumonia complicated with pneumothorax].

In patients with human immunodeficiency virus infection, pneumothorax overcomes in advanced stages of the illness, associated with infections by Mycobacterium tuberculosis or Pneumocystis jiroveci, in smokers and intravenous drug users. We present a case with this unusual complication: homosexual man, 30 years of age, with a history of one month of cough, progressive dyspnea, weight loss and diarrhea. He was hospitalized with the diagnosis of atypical pneumonia, respiratory failure and a presumptive HIV infection. His clinical course was complicated by the presence of bullae and pneumothorax by day 15 of hospitalization. The existence of Pneumocystis jiroveci in sputum was confirmed by a direct immunofluorescence test. The patient was treated with sulpha-trimethoprim, steroids, oxygen, but he died 21 days after admittance. The strategies recommended for treatment of pneumothorax appeared during P. jiroveci pneumonia in HIV positive patients are summarized.