Bronchiolitis obliterans presenting as subcutaneous emphysema and pneumomediastinum: A case report

We describe a woman post allogeneic bone marrow transplantation (BMT), who presented to the emergency room with subcutaneous emphysema and pneumomediastinum as the first manifestation of bronchiolitis obliterans complicating mild chronic graft versus host disease (GVHD). In contrast to other patients with pneumomediastinum described in the literature, this patient suffered from only mild GVHD. She did not receive methotrexate as GVHD prophylaxis, and the peumomediastinum was a presenting manifestation rather than a terminal event. In addition, this is the first description of subcutaneous emphysema with this setting. Therefore, bronchiolitis obliterans should be highly suspected in post-BMT patients presenting with pneumomediastinum and subcutaneous emphysema, and prompt therapy should be initiated.