COVID-19 and spontaneous pneumomediastinum: a rare complication

摘要

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/mm3 ); 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).