A novel approach to resolve severe mediastinal and subcutaneous emphysema occurring in Pneumocystis jirovecii pneumonia using vacuum-assisted closure therapy

Noor H Bouwmeester; Hans Kieft; Ghada Mm Shahin; Arno P Nierich

doi:10.1177/2050313X20918989

A novel approach to resolve severe mediastinal and subcutaneous emphysema occurring in Pneumocystis jirovecii pneumonia using vacuum-assisted closure therapy

SAGE Open Med Case Rep. 2020 May 8:8:2050313X20918989. doi: 10.1177/2050313X20918989. eCollection 2020.

Authors

Noor H Bouwmeester¹, Hans Kieft¹, Ghada Mm Shahin², Arno P Nierich³

Affiliations

¹ Department of Intensive Care, Isala, Zwolle, The Netherlands.
² Department of Cardiothoracic Surgery, Isala, Zwolle, The Netherlands.
³ Department of Cardiothoracic Anesthesiology, Isala, Zwolle, The Netherlands.

Abstract

A 50-year-old human immunodeficiency virus positive patient who was diagnosed with Pneumocystis jirovecii pneumonia developed severe subcutaneous and mediastinal emphysema, which was progressive despite low pressure mechanical ventilation. Infraclavicular skin incisions and vacuum-assisted closure therapy were used to resolve the emphysema. The subcutaneous emphysema decreased significantly, and after 1 week the vacuum-assisted closure therapy was ended successfully. This technique has previously been described in several case reports, where it is a promising treatment in severe subcutaneous emphysema, but it is not yet widely used. This case report supports the further use of vacuum-assisted closure therapy in subcutaneous emphysema. Successful treatment of severe mediastinal and subcutaneous emphysema in Pneumocystis jirovecii pneumonia can be achieved by vacuum-assisted closure therapy on infraclavicular skin incisions.

Keywords: Pneumocystis; mediastinal emphysema; negative-pressure wound therapy; subcutaneous emphysema; vacuum-assisted closure therapy.

Publication types

Case Reports