Acquired Tracheal Stenosis in an HIV-Positive Child Presenting with Persistent Respiratory Symptoms after Being Ventilated for Pneumocystis jirovecii Pneumonia and Cytomegalovirus Pneumonia: Diagnosis and Management in a Severely Immunosuppressed Child

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INTRODUCTION: Pneumocystis jirovecii pneumonia (PJP) is a significant cause of morbidity and mortality in children with advanced HIV disease (AHD) and other immunosuppressive conditions. Acquired tracheal stenosis in children living with HIV (CLHIV) has not been described. CASE PRESENTATION: A 4-month and 3-week-old child living with HIV presented with persistent respiratory symptoms after mechanical ventilation for 10 days for confirmed PJP and cytomegalovirus (CMV) pneumonia at the age of 3 months and 1 week. She tested positive for HIV at 3 months of age and had a high viral load of log 2.7 copies/mL. She was re-admitted to the PICU with multilobar pneumonia, requiring non-invasive ventilation with metapneumovirus identified from nasopharyngeal aspirate. Persistent wheeze and stridor were noted. During hospitalization, the mother was diagnosed with confirmed tuberculosis (TB). The child was referred for bronchoscopy due to the possibility of pulmonary TB and airway compression. A chest CT scan revealed short segment tracheal stenosis of >50% but no signs of TB as a possible cause. Bronchoscopy demonstrated significant narrowing occurring in the midtracheal region with the acquired nature configuration. The stenosis was successfully dilated twice, first with rigid bronchoscopy, followed by dilatation with flexible bronchoscopy and an angioplasty balloon. CONCLUSION: Acquired tracheal stenosis in CLHIV is not well documented, although many young children with HIV infection have been ventilated for severe pneumonia. Bronchoscopy should be considered in children with persistent respiratory symptoms, and endoscopic procedures can be safely performed in immunosuppressed children.

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