Abstract
PurposeThe Coronavirus Disease 2019 (COVID-19) may result not only in acute symptoms such as severe pneumonia, but also in persisting symptoms after months. Here we present a 1 year follow-up of a patient with a secondary tension pneumothorax due to COVID-19 pneumonia.Case presentationIn May 2020, a 47-year-old male was admitted to the emergency department with fever, dry cough, and sore throat as well as acute chest pain and shortness of breath. Sputum testing (polymerase chain reaction, PCR) and computed tomography (CT) confirmed infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Eleven days after discharge, the patient returned to the emergency department with pronounced dyspnoea after coughing. CT showed a right-sided tension pneumothorax, which was relieved by a chest drain (Buelau) via mini open thoracotomy. For a period of 3 months following resolution of the pneumothorax the patient complained of fatigue with mild joint pain and dyspnoea. After 1 year, the patient did not suffer from any persisting symptoms. The pulmonary function and blood parameters were normal, with the exception of slightly increased levels of D-Dimer. The CT scan revealed only discrete ground glass opacities (GGO) and subpleural linear opacities.ConclusionTension pneumothorax is a rare, severe complication of a SARS-CoV-2 infection but may resolve after treatment without negative long-term sequelae.Level of evidenceV.
Highlights
The first infections with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) were detected in humans in late 2019 [1]
In June 2020, we reported a case of a secondary tension pneumothorax as a complication of COVID-19 pneumonia [4]
Fumagalli et al examined the respiratory function at the time of clinical recovery and 6 weeks after discharge in 13 patients surviving COVID-19 pneumonia
Summary
The first infections with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) were detected in humans in late 2019 [1]. The patient was treated for COVID-19 pneumonia with supportive measures and discharged with lowering CRP levels as well as normalized leucocytes and interleukine-6 levels after 7 days. Eight days after second admission, thoracic X-rays showed right-sided soft tissue emphysema and bipulmonary opacities due to COVID-19 pneumonia. Thoracic X-ray performed 1 month after second discharge from the hospital showed regressive pulmonary opacities due to COVID-19 pneumonia. No persisting symptoms CT: complete remission of the pneumothorax, discrete GGO and subpleural linear opacities PFTS: normal CBG: normal in resting position and at 60 W exercise Blood samples: D-dimer slightly increased Antibodies: SARS-COV-2S-AB (IgG) 4,1; S-AB (total 698, N-AB (total) reak. CT scans acquired 5 and 12 months after second discharge showed complete remission of the pneumothorax and almost complete remission of the pulmonary abnormalities due to COVID-19 pneumonia. One year after discharge the CD4 count was 1195 cells/μl (45% of lymphocytes) and CD4/CD8 ratio 0.91
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