COVID-19 pneumonia complicated by late presentation of bilateral spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema

Abstract

Introduction. Over the last few months the coronavirus disease 2019 (COVID-19) pandemic has created overwhelming challenges for physicians around the world. While much has been described in the literature about lung infiltrates and respiratory failure associated with infection of coronavirus 2 (SARSCoV- 2), pneumothorax is reported as a rare (a rate of 1%) but a life-threatening complication of COVID-19 pneumonia. Late bilateral spontaneous pneumothorax has been described in few cases. The aim of the report is to consider pneumothorax as a possible complication of COVID-19 pneumonia, which is also one of the causes of respiratory deterioration and potentially fatal outcome in these patients. Case outline. This article describes the clinical course of the patient who tested positive for SARS-CoV-2 on reverse-transcriptase polymerase chain reaction (RT-PCR) testing of nasopharyngeal and oropharyngeal swab specimens and who presented with COVID-19 pneumonia complicated by bilateral, spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema. He had no underlying lung disease nor risk factors for pneumothorax, except administered non-invasive ventilation/continuous positive airway pressure during first hospitalization. The patient was successfully treated with surgical (chest drainage, thoracoscopy and pleural abrasion) and non-surgical methods (by application of drugs and other supportive therapies). Conclusion. This review demonstrates that the possibility of a late pneumothorax should be kept in mind in patients with, or recovering from, COVID-19 disease with progressive dyspnea. The timely diagnosis and management of pneumothorax will reduce COVID-19 associated mortality.