key: cord-0694910-n8oj9p5i authors: Zayet, Souheil; Klopfenstein, Timothee; Mezher, Chaouki; Gendrin, Vincent; Conrozier, Thierry; Ben Abdallah, Yousri title: COVID-19 with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema date: 2020-10-14 journal: New Microbes New Infect DOI: 10.1016/j.nmni.2020.100785 sha: 018cb4585550b9432ac3d6a52e7111f2cf07e1d5 doc_id: 694910 cord_uid: n8oj9p5i • Complications such as pneumomediastinum and/or pneumothorax during the course of COVID-19 remain rare and their mechanism is poorly described. • We present a case of COVID-19 pneumonia associated with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in an immunocompetent patient with no past history of smoking or chronic obstructive pulmonary disease (COPD). • This is the first case of spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema due to COVID-19 in France. • The only risk factor of this patient was prolonged cough. • We hypothesis the mechanism underlying the pneumomediastinum is the aggressive disease pathophysiology in COVID-19 with an incresead risk of alveolar damage. On December 2019, an outbreak of pneumonia began in the city of Wuhan The precise mechanism of spontaneous pneumothorax and/or pneumomediastinum is unknown in patient with COVID-19. To our knowledge, only few cases have been reported in medical literature (6) (7) (8) (9) (10) . The particularity of our observation is that our patient had spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema at the same time, with no past history of smoking or COPD. The only risk factor of this patient was prolonged cough. Usually, spontaneous rupture of a small J o u r n a l P r e -p r o o f subpleural bulla is the cause of primary pneumothorax (11) . Spontaneous pneumomediastinum is defined as the presence or the appearance of free air in the mediastinum, typically in the absence of iatrogenic injury or external trauma. It is habitually an alveolar rupture due to an increase in intrathoracic pressure, with a dissection of air through the bronchovascular sheath into the mediastinum. Next, subcutaneous emphysema occurs when air penetrates the tissues under the skin (12) . In our case, we hypothesize that the mechanism these simultaneous complications is the aggressive disease pathophysiology in COVID-19 with an increased risk of alveolar damage. Acute deterioration with rapid oxygen desaturation with several parenchymal involvements in a COVID-19 patient could indicate pneumothorax and/or pneumomediastinum and requires the performance of CT control. No conflict of interests. Imaging features and mechanisms of novel coronavirus pneumonia (COVID-19): Study Protocol Clinical Trial (SPIRIT Compliant) Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2 Mediastinal Emphysema, Giant Bulla, and Pneumothorax Developed during the Course of COVID-19 Pneumonia Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Pneumomediastinum following intubation in COVID-19 patients: a case series COVID-19 with spontaneous pneumomediastinum COVID-19 with spontaneous pneumothorax,pneumomediastinum and subcutaneous emphysema Spontaneous Pneumomediastinum: A Probable Unusual Complication of Coronavirus Disease 2019 (COVID-19) Pneumonia Secondary tension pneumothorax in a COVID-19 pneumonia patient: a case report Spontaneous Pneumothorax Following COVID-19 Pneumonia Spontaneous pneumothorax: epidemiology, pathophysiology and cause Subcutaneous and mediastinal emphysema. Pathophysiology, diagnosis, and management