A Case of Spontaneous Pneumothorax 21 Days After Diagnosis of Coronavirus Disease 2019 (COVID-19) Pneumonia

Abstract

BACKGROUND At the end of 2019, coronavirus (SARS-CoV-2) was recognized as the cause of a cluster of pneumonia cases in Wuhan, a city in China. There are numerous complications associated with COVID-19 infection, such as acute respiratory distress syndrome, renal failure, circulatory shock, and multi-organ failure. Spontaneous pneumothorax following COVID-19 pneumonia is an extremely rare complication. CASE REPORT We report the case of a 49-year-old man with a past medical history of type 2 diabetes mellitus with an initial presentation of cough, shortness of breath, and fever. He was diagnosed with COVID-19 pneumonia and rapidly deteriorated on the day of admission, requiring initiation of mechanical ventilation. The patient recovered clinically and was discharged home. He returned 21 days after discharge with a spontaneous pneumothorax. CONCLUSIONS Spontaneous pneumothorax is a rare complication after apparent recovery from COVID-19 pneumonia. It is imperative that treating physicians are aware of this complication in order to recognize it early and treat it promptly.

Figure 1.

Chest x-ray during the initial admission shows bilateral infiltrate mainly prominent in lower lobes at time of initial presentation.

Figure 2.

Left-sided pneumothorax (A) and after pigtail insertion (B). There was an interval decrease of the left pneumothorax, from 21 mm to 8 mm in thickness, at the apex after the pigtail insertion.

Figure 3.

CT scan of the chest without contrast after pigtail insertion. Left pleural catheter is in position with approximately 27% volume left pneumothorax. Bilateral upper and lower lobe airspace infiltrates/consolidation are noted, left more pronounced than right.