key: cord-1006379-lnhq6znz
authors: Shah, Viraj; Brill, Katie; Dhingra, Gunmeet; Kannan, Santhana
title: Delayed recurrent spontaneous pneumothorax in a patient recovering from COVID-19 pneumonia
date: 2020-09-01
journal: Korean J Anesthesiol
DOI: 10.4097/kja.20400
sha: 1547807826a2c1b2f6a3c98cf29f49f4346a080a
doc_id: 1006379
cord_uid: lnhq6znz

nan

Pneumothorax in COVID-19 pneumonia can be a presenting feature or develop in the acute phase [1] . Hollingshead and Hanrahan [2] reported on a patient who presented with loculated pneumothorax in the fourth week of illness. There have been no reports of recurrent delayed spontaneous pneumothorax occurring several weeks later. Our report suggests that pneumatoceles could be the precursor for the development of pneumothorax in COVID-19. In an autopsy series of 38 patients, Carsana et al. [3] found that loss of pneumocytes was present in 100% of the cases, with a multifocal distribution comprising the majority. The mean duration of hospitalization in this series was only 7 days, with a maximum of 23 days. It is possible that the process of lung destruction continues with a longer duration of illness.

Although the first pneumothorax was expected on the same side as that of the pneumatoceles, it developed on the contralateral side in this patient. The speed at which the pneumatoceles developed is notable. In previous case reports, the pneumomediastinum and pneumothorax resolved with time [4] . While the pneumomediastinum did resolve in our patient, the pneumatoceles not only persisted but new ones continued to appear much later in the clinical course, despite the repeat sample testing negative for COVID-19. Klebsiella pneumonia has been associated with the formation of pneumothorax and empyema [5] . In all such cases, the bacterium is cultured from the sputum or pus specimen. In our patient, Klebsiella was cultured from blood and not from any of the sputum specimens. The pleural drain fluid was not puru-lent. Thus, it is unlikely that the pneumothorax was caused by the Klebsiella infection.

This report highlights the need for a high index of suspicion for pneumothorax in patients with severe COVID-19 pneumonia, when they deteriorate acutely after appearing to stabilize. Considering that this can happen in very late stages of the disease when there is no sign of an active infection, close monitoring is required in the presence of radiological evidence of pneumatoceles. 

Mediastinal emphysema, giant bulla, and pneumothorax developed during the course of COVID-19 pneumonia

Spontaneous pneumothorax following COVID-19 pneumonia

Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study

COVID-19 with spontaneous pneumomediastinum

Klebsiella pneumonia with pneumothorax, pneumomediastinum and pneumoperitoneum

The authors gratefully acknowledge the support of Dr. SR Haynes and Dr. WPM Chan.

Viraj Shah, https://orcid.org/0000-0001-6282-2518 Katie Brill, https://orcid.org/0000-0002-5838-4460 Gunmeet Dhingra, https://orcid.org/0000-0002-0333-0369 Santhana Kannan, https://orcid.org/0000-0003-3685-2056

No potential conflict of interest relevant to this article was reported.