key: cord-0794403-9gd9zc7r
authors: de Albuquerque, Júlio Holanda Cavalcanti; da Silva, Angélica Maria Holanda Pascoal; de Almeida, Tássia Ívila Freitas; Farias, Luís Arthur Brasil Gadelha
title: COVID-19 and spontaneous pneumomediastinum: a rare complication
date: 2021-02-26
journal: Revista da Sociedade Brasileira de Medicina Tropical
DOI: 10.1590/0037-8682-0871-2020
sha: e89a1491b7b4338e69a2dde31547c685857de253
doc_id: 794403
cord_uid: 9gd9zc7r

nan

www.scielo.br/rsbmt I www.rsbmt.org.br

Júlio Holanda Cavalcanti de Albuquerque [1] , Angélica Maria Holanda Pascoal da Silva [1] , Tássia Ívila Freitas de Almeida [1] and Luís Arthur Brasil Gadelha Farias [2] [1]. Hospital Geral de Fortaleza, Serviço de Clínica Médica, Fortaleza, CE, Brasil. [2] . Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil. A 42-year-old man presented with a 9-day history of fever (39°C), cough, odynophagia, myalgia, and dyspnea. His symptoms had worsened 2 days prior to presentation. Physical examination revealed mild respiratory distress-respiratory rate, 35 rpm; heart rate, 140 bpm; and blood oxygen saturation level without supplementary oxygen, 91%. Chest examination revealed reduced vesicular breath sounds in both lung bases. On admission, he had normal blood cell, platelet, and leukocyte counts; lymphopenia (lymphocyte count: 676/mm 3 ); high C-reactive protein level (391.35 mg/L); normal hepatic and renal functions; and normal D-dimer, troponin, aspartate transaminase, alanine transaminase, lactate dehydrogenase, and ferritin levels. Chest computed tomography (CT) revealed spontaneous pneumomediastinum and bilateral ground-glass opacities (Figure 1A) . He was diagnosed with coronavirus disease (COVID-19) using reverse-transcription polymerase chain reaction analysis of a nasopharyngeal swab specimen and received a 5-day regimen of methylprednisolone (40 mg/day), hydroxychloroquine (400 mg/day), azithromycin (500 mg/day), and ceftriaxone (2 g/day). During hospitalization, he was weaned of oxygen support and discharged after 10 days. Chest CT on discharge revealed resorption of the pneumomediastinum (Figure 1B ).

Spontaneous pneumomediastinum is usually self-limiting, as in this case. Thus, only a few COVID-19-related pneumomediastinum cases with fatal outcomes have been reported 1 . An emerging pressure gradient between the alveoli and surrounding structures may cause alveolar rupture, with air leaking into the interstitium, following the bronchovascular bundle toward the hilum and spreading through the mediastinum 2,3 . Although this is a rare manifestation of COVID-19, physicians in pandemic settings should be aware of this complication.

Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease

Case report: pneumothorax and pneumomediastinum as uncommon complications of COVID-19 pneumonia-literature review

Pneumomediastinum in a patient with COVID-19

We thank the patient who agreed to participate in the study.

Albuquerque JHC et al. -COVID-19 and spontaneous pneumomediastinum

JHCA: Conceptualization, writing first draft; AMHPS, TIFA: Resources, data collection, visualization, validation, review; AMHPS also work in the article supervision; LABGF: Writing first draft and manuscript review, as well as supervision.

The authors declare that there is no conflict of interest.