Pneumothorax as the presenting sign ofPneumocystis carinii infection in an HIV-positive child with prior lymphocytic interstitial pneumonitis

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Abstract
An HIV-positive child presented with a pneumothorax secondary to cavitaryPneumocystis carinii pneumonia (PCP). Lymphocytic interstitial pneumonitis had been evident on earlier radiographs but had resolved, concurrent with a decrease in her CD4 counts, before the radiographic changes of PCP became evident. As immune function declines in HIV-positive children, the chest radiograph may paradoxically clear. In such a setting, development of focal lung disease, including pneumothorax, may heraldPneumocystis carinii infection.