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Vol. 34. Issue 4.
Pages 184-188 (April 1998)
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Vol. 34. Issue 4.
Pages 184-188 (April 1998)
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Neumotorax espontáneo asociado a la infección por el virus de la inmunodefíciencia humana (VIH)
Spontaneous pneumothorax associated with human immunodeficiency virus (HIV) infection
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R. Golpe Gómez1, J.M. Cifrián Martínez, S.M. Fernández Rozas, M.M. García Pérez, A. Jiménez Gómez
Sección de Neumología. Hospital Universitario Marqués de Valdecilla. Santander
R. Mons Lera*
* Servicio de Cirugía Torácica. Hospital Universitario Marqués de Valdecilla. Santander
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El neumotórax espontáneo (NE) es una complicación relativamente frecuente en pacientes infectados por el VIH. Setecientos sesenta y cinco pacientes con infección por el VIH fueron tratados en el Hospital Universitario Marqués de Valdecilla entre 1990 y 1996. Nueve pacientes presentaron algún episodio de NE. De éstos, seis (66%) presentaron una neumonía por Pneumocystis carinii (NPC) previa o simultáneamente a la aparición del neumotorax. En 3 pacientes (33%) se relacionó la aparición de los neumotórax con una tuberculosis (TB) activa o antigua. En el 55% de los enfermos se había empleado profilaxis con pentamidina nebulizada. El drenaje torácico simple tuvo éxito en el control inicial de los neumotórax en el 58% de los episodios en que se usó, aunque con una tasa de recurrencias del 71%. La pleurodesis con talco a través del tubo torácico se usó con éxito en 3 pacientes; en dos de éstos se empleó por existir evidencias de fuga aérea persistente, no controlada con el drenaje simple, y falló la primera vez que se utilizó, pero controló el neumotorax al usarse en un segundo tiempo. La tasa de mortalidad de nuestra serie fue del 66%, con un tiempo de supervivencia medio de 55,6 días. Concluimos que el NE predice un mal pronóstico en los pacientes infectados por el VIH. La NPC y la TB, previas o concurrentes, fueron los factores etiológicos hallados en los pacientes. El drenaje torácico simple se asoció a una elevada tasa de recurrencias, por lo que parece prudente realizar pleurodesis profiláctica en todos los casos.

Palabras clave:
Seropositividad para el VIH
Neumotórax
Sida

Spontaneous pneumothorax is a relatively frequent complication of human immunodeficiency virus (HIV) infection. Seven hundred sixty-five HIV-infected inpatients were treated at Marqués de Valdecilla University Hospital between 1990 and 1996. Spontaneous pneumothorax developed in 9 patients. Pneumocystis carinii pneumonia was diagnosed in 6 patients (66%), either before or sirnultaneous to the appearace of pneumothorax. Pneumothorax was related to active or old tuberculosis infection in 3 patients (33%). Prophylactic therapy with nebulized pentamidine was used in 55% of the patients. Successful initial control of pneumothorax was achieved with simple drains in 58% of the episodes, although the recurrence rate was 71%. Pleurodesis with talcum with a chest tube was used successfully in 3 patients, in 2 because of sings of persistent air leakage uncorrected by simple drainage. Pleurodesis initially failed but later controlled pneumothorax the second time it was used. The mortality rate in this series was 66%, with a mean survival time of 55.6 days. We conclude that Spontaneous pneumothorax is associated with poor prognosis in HIV infected patients. Prior or concurrent P. carinni pneumonia or tuberculosis were the etiologic factors identified in our patients. A simple pleural drain was associated with a high rate of recurrence, such that prophylactic pleurodesis seems warranted in all patients.

Key words:
HIV seropositivity
Pneumothorax
AIDS
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Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
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