Abstract
PurposeEspecially in elderly and multimorbid patients, Coronavirus Disease 2019 (COVID-19) may result in severe pneumonia and secondary complications. Recent studies showed pneumothorax in rare cases, but tension pneumothorax has only been reported once.Case presentationA 47-year-old male was admitted to the emergency department with fever, dry cough and sore throat for the last 14 days as well as acute stenocardia and shortage of breath. Sputum testing (polymerase chain reaction, PCR) confirmed SARS-CoV-2 infection. Initial computed tomography (CT) showed bipulmonary groundglass opacities and consolidations with peripheral distribution. Hospitalization with supportive therapy (azithromycin) as well as non-invasive oxygenation led to a stabilization of the patient. After 5 days, sputum testing was negative and IgA/IgG antibody titres were positive for SARS-CoV-2. The patient was discharged after 7 days.On the 11th day, the patient realized pronounced dyspnoea after coughing and presented to the emergency department again. CT showed a right-sided tension pneumothorax, which was relieved by a chest drain (Buelau) via mini open thoracotomy. Negative pressure therapy resulted in regression of the pneumothorax and the patient was discharged after 9 days of treatment.ConclusionTreating physicians should be aware that COVID-19 patients might develop severe secondary pulmonary complications such as acute tension pneumothorax.Level of evidenceV
Highlights
Since its first description in Wuhan, Hubei Province, China, in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a pandemic, which was Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.1 3 Vol.:(0123456789) Case reportA 47-year-old male was admitted to our emergency department with dry cough, shortness of breath and stenocardia
Reports of pneumothorax as a complication of COVID-19 are rare, and we describe a case of secondary tension pneumothorax
Because of human immunodeficiency virus (HIV) infection, the patient was under treatment with Dovato® 50/300 mg (GSK®, Dolutegravir/ Lamivudine)
Summary
Fever, shortness of breath and stenocardia had lasted for 14 days before primary admission. Blood gas analysis (arterial) at admission showed a pH of 7.49, PCO2 of 32.6 mmHg, PO2 of 110 mmHg, and SaO2 at 98.9% with 5L/min oxygen applied by nasal cannula, which was reduced to 3L/min oxygen, resulting in a peripheral O 2 saturation of 95%. Antibody titres (Anti-SARS-CoV-2-IgG and Anti-SARSCoV-2-IgA) were positive and SARS-CoV-2-RNA N-gene 1 (PCR) was negative 5 days after primary admission. The patient was discharged with lowering CRP levels as well as normalized leucocytes and interleukine-6 levels after 7 days. 11 days after primary admission, the patient admitted again to the emergency department with pronounced dyspnoea after coughing.
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