Subcutaneous emphysema and spontaneous pneumomediastinum in non-intubated COVID-19 patient: Presenting unusual case report

Introduction and importance: In non-intubated COVID-19 patients, subcutaneous emphysema and spontaneous pneumomediastinum (SPM) remain rarely, with incidence rates of 3.0 and 1.2 per 100,000, respectively; nevertheless, the occurrence of these conditions in COVID-19 patients is unclear. Up to date only few cases have been reported. The mechanism of pneumomediastinum in non-intubated COVID-19 patients remains unclear. Case presentation: Here we present a 63-year-old male with subcutaneous emphysema, and spontaneous pneumomediastinum with a 1-day history of chest pain and productive cough, without chills and dyspnea. The patient was diagnosed by nasopharyngeal RT-PCR, Chest CT, and laboratory findings. The patient successfully treated by given double (mask and nasal) oxygen therapy, antibacterial (moxifloxacin tablet 400 mg) every 24 h for 7 days, followed by antiviral (lopinavir tablet 400 mg) twice daily for 6 days and corticosteroid treatments as well as steroid therapy (methylprednisolone 40 mg) daily for 8 days. Subcutaneous emphysema treated by supraclavicular slit-like incision (3 cm) bilaterally and milking of skin from face, neck, shoulders and chest done for three days for subcutaneous emphysema but regarding the pneumomediastinum we did only follow up of the patient. Clinical discussion: Spontaneous pneumomediastinum and subcutaneous emphysema are rare clinical finding in non-intubation of COVID-19 patients but frequently common in patients with coronavirus acute respiratory distress syndrome (COV-ARDS), or intubated COVID-19. In the present paper, subcutaneous emphysema and spontaneous pneumomediastinum occurred at the same time, with no past history of pulmonary diseases, and smoking of the patient. The only reason of this patient was high-pressure repetitive cough. Conclusion: The authors declared that COVID-19 infection leading to subcutaneous emphysema and spontaneous pneumomediastinum in non-intubated COVID-19 patients. Our case revealed that oxygen therapy, bed rest, analgesic, and supraclavicular slit-like incision best option for treat subcutaneous emphysema (SE) and spontaneous pneumomediastinum (SPM).