Spontaneus pneumomediastinum and subcutaneus emphysema in nonventilated COVID-19 patient

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IntroductionThe most common complications of COVID-19 infection are: pneumonia, acute respiratory distress syndrome, pulmonary fibrosis, pulmonary embolism, pneumothorax and pneumomediastinum.AimWe would like to highlight the rarity of pneumomediastinum and subcutaneous emphysema in nonventilated COVID-19 patient.Case studyA 50-year-old man was addmitted to the COVID-19 Department with SARS-CoV-2 pneumonia. The patient wasn’t vaccinated against COVID- 19. Upon admission the general condition was quite good with mild dyspnea.Results and discussionUpon admission a CT scan was performed in which there were bilateral infiltrates consistent with COVID-19 infection, covering approximately 50% of the lungs. On the 5th day of hospitalization the general condition deteriorated and a drop in saturation was observed. A follow-up CT scan revealed progression of lung inflammatory changes that spanned approximately 60%–70% of lung parenchyma; there was pneumomediastinum and subcutaneous emphysema in the neck, left subclavian, and axillary area. High flow nasal oxygen therapy (60 L/min) was administered. On the 13th day the general condition of the patient further deteriorated and blood saturation continued to drop which prompted the decision to escalate treatment. Initially, noninvasive ventilation was used, however, shortly after the patient was intubated. Immediately after intubation the patient went into cardiac arrest that ultimately led to his death.ConclusionsThe development of spontaneus pneumomediastinum in the patient can be mainly attributed to the intense cough and rapidly developing acute respiratory distress syndrome in the course of SARS-CoV-2 infection despite aggressive treatment with steroids, tolicizumab, and antibiotics for staphylococcal pneumonia.