TYPE: Case Report
TOPIC: Cardiothoracic Surgery
INTRODUCTION: Corona Virus Disease-2019 (COVID-19) is the current global health concern and it is a syndemic affecting many aspects of health in entire world. Sequale of COVID-19 are numerous and sometimes fetal. Spontaneous pneuumomediastinum is reported infrequently. Here we present a patient with ongoing COVID-19 complicated with organizing pneumonia and pneumomedistinum/pneumothorax.
CASE PRESENTATION: A 52 year old man with diabetes and ischaemic heart disease presented to the local hospital with features of moderate COVID-19 pneumonia. On admission he was hypoxaemic requiring 3 L of oxygen via nasal prong. Initial inflammatory markers were elevated along with neutrophil leukocytosis and normalized with empirical antibiotics and dexamethazone 6mg daily. However, his procalcitonin was throughout negative. His oxygen requirement remained static and x-ray was suggestive of COVID-19 pneumonia. He did not require additional ventilator support and anti IL-6 agents. His routine drugs were continued along with anicoagulation. Even beyond day 21, it was unable to tail-off oxygen and repeat x-ray revealed pneumomediastinum and inflamatory/fibrotic lung feilds. High-Resolution Computed-Tomography confirmed the diagnosis of organizing pneumonia with fibrotic elements and extensive pneumomediatinum with mild pneumothorax. Other aetilogies such as tuberculosis / Pneumocystis jiroveci pneumonia / fungal infections were actively excluded. Methylprednisolone pulse was given followed by oral steroids. Pneumomediastinum was managed conservatively.
DISCUSSION: Fibrinous organizing pneumonia is a known sequale of COVID-19 and inturn can lead to pneumothorax and pneumomediastinum. Even without organizing pneumonia COVID-19 is associated with them. Howeveer, those are common among patients who were on ventilatory supports.
CONCLUSIONS: These complications should be sought in a non-improving COVID-19 patient.
DISCLOSURE: Nothing to declare.
KEYWORD: pneumomediastinum