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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A case report described four men, aged 38−75 years, who developed spontaneous pneumomediastinum or subcutaneous emphysema during off label treatment with dexamethasone for COVID-19 pneumonia [routes, dosages, and outcomes not stated].
Case 1: The 45-year-old man was admitted to a hospital in India with severe acute respiratory distress syndrome secondary to COVID-19 pneumonia. His comorbidities included systemic hypertension and chronic kidney disease. He received off label treatment with dexamethasone and azithromycin along with remdesivir and heparin. Additionally, he received oxygen support. On day 2 of admission, he developed spontaneous pneumomediastinum and subcutaneous emphysema. Subsequently, he was intubated on day 9 due to worsening of COVID-19 pneumonia and eventually died on day 21 due to COVID-19 pneumonia. Acute lung injury due to COVID‑19 pneumonia and dexamethasone treatment were considered as a pre-disposing factor for spontaneous pneumomediastinum and subcutaneous emphysema.
Case 2: The 38-year-old man was admitted to a hospital in India with severe acute respiratory distress syndrome secondary to COVID-19 pneumonia. His comorbidities included post renal transplant chronic kidney disease requiring maintenance haemodialysis. He received off label treatment with dexamethasone and azithromycin along with remdesivir and heparin. Additionally, he received oxygen support. On day 3 of admission, he developed spontaneous pneumomediastinum. Subsequently, he was intubated on day 11 due to worsening of COVID-19 pneumonia and eventually died on day 14 due to COVID-19 pneumonia. Acute lung injury due to COVID‑19 pneumonia and dexamethasone treatment were considered as a pre-disposing factor for spontaneous pneumomediastinum.
Case 3: The 75-year-old man was admitted to a hospital in India with severe acute respiratory distress syndrome secondary to COVID-19 pneumonia. His comorbidities included systemic hypertension and diabetes mellitus. He received off label treatment with dexamethasone and azithromycin along with remdesivir and heparin. Additionally, he received oxygen support. On day 5 of admission, he developed subcutaneous emphysema. Subsequently, he was intubated on day 12 due to worsening of COVID-19 pneumonia and eventually died on day 14 due to COVID-19 pneumonia. Acute lung injury due to COVID‑19 pneumonia and dexamethasone treatment were considered as a pre-disposing factor for subcutaneous emphysema.
Case 4: The 43-year-old man was admitted to a hospital in India with severe acute respiratory distress syndrome secondary to COVID-19 pneumonia. His comorbidities included systemic hypertension and coronary artery disease. He received off label treatment with dexamethasone and azithromycin along with remdesivir and heparin. Additionally, he received oxygen support. On day 4 of admission, he developed spontaneous pneumomediastinum and subcutaneous emphysema. Later, his condition improved, and he was discharged home in stable condition on day 12. Acute lung injury due to COVID‑19 pneumonia and dexamethasone treatment were considered as a pre-disposing factor for spontaneous pneumomediastinum and subcutaneous emphysema.
Reference
- Cherian A, et al. Unusual complications of spontaneous pneumomediastinum and subcutaneous emphysema in patients with SARS-CoV-2 infection: A case report. Indian Journal of Anaesthesia 65: 483-486, No. 6, Aug 2021. Available from: URL: http://www.ijaweb.org/backissues.asp [DOI] [PMC free article] [PubMed]