COVID-19 with spontaneous pneumomediastinum.

A 38-year-old man from Wuhan, China, was admitted to the Central Hospital of Wuhan (Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China), on Jan 20, 2020, with a 1-day history of fever without dizziness, cough, and headaches. On presentation, his temperature was 38·1°C. Laboratory tests showed a C-reactive protein concentration of 0·56 mg/dL (normal range 0·00–0·60] mg/dL). Complete blood count showed elevated leukocytes (10 060 cells per μL [normal range 3500–9500 cells per μL]), neutrophils (7550 cells per μL [1800–6300 cells per μL]), and monocytes (990 cells per μL [100–600 cells per μL]), while the lymphocyte count (1490 cells per μL) was in the normal range (1100–3200 cells per μL). The patient was negative for influenza A and B viruses, adenovirus, respiratory syncytial virus, and parainfluenza 1, 2, and 3 viruses. Chest CT showed multiple ground-glass opacities in the lower lobes bilaterally.
The patient was given antibacterial, antiviral, and corticosteroid treatments (moxifloxacin [0·4 g/day] for 5 days, followed by ribavirin [0·5 g/day] and methylprednisolone [40 mg/day] for 5 days) via intravenous drop infusion. However, after 10 days, the patient had persistent fever (highest temperature 38·5°C), cough, and shortness of breath. The patient was diagnosed with coronavirus disease 2019 (COVID-19) on the basis of RT-PCR analysis of sputum samples. On day 11, the patient developed exertional angina with cardiac palpitations along with respiratory wheezing. Chest CT revealed multiple ground-glass opacities with bilateral parenchymal consolidation and interlobular septal thickening. Spontaneous pneumomediastinum and subcutaneous emphysema were also observed (figure).


Author: Changyu Zhou, Chen Gao, Yuanliang Xie, et al.