Case report.
Identity : Male, 38 years old.
Main complaint : 1 day fever.
Current medical history :
- Fever without dizziness.
- Cough.
- Headache 1 day before. He was later treated at the Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China.
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Physical checkup.
Vital signs (Body temperature : 38,1°C)
Supporting investigation :
Chest CT Scan ➡
- Found many Ground Glass Opacities (GGO) in the lower lobes of bilatera.
- Pneumomediastinum Spontaneous (Arrow Signs), Subcutaneous Emphysema, and Bilateral Ground Glass Opacities.
Treatment.
- Moxifloxacin 0,4gram/day (for 5 days).
- Continued ribavirin 0,5 gram/day.
- Metiplrednisolone 40 mg/day IV drip (for 5 days).
Follow up.
Day 10 ➡
- Persistent fever (38,5°C).
- Cough.
- Out of breath.
Diagnosis :
COVID-19 (via Rapid Test-PCR)
Day 11 ➡
- Exertional angina.
- Palpitations.
- Wheezing.
CT Scan ➡
- Ground Glass Opacities with bilateral parenchymal consolidation are shown.
- Septal interlobular thickening.
- Spontaneous pneumomediastinum appears.
- Subcutaneous emphysema.
Treatment.
- Giving corticosteroids is stopped.
- Ribavirin with the same dose continued for 14 days.
- Providing additional oxygen.
- Theophylline (0,2 gram/12 hours).
- Ambroxol (45 mg/12 hours).
- Cefoperazone-tazobactam (2 grams/8 hours) per IV.
- Recombinant human alpha-1b interferon aerosol (3 ×/day, for 14 days).
Day 25 ➡
- The temperature returned to normal (36,5°C).
- Coughing is reduced.
- Breath returned to normal.
- Rapid Test-PCR : negative COVID-19.
Chest CT Scan :
- Pneumomediastinum repair and parenchymal consolidation, with fibrosis and pneumatocele in the lower left lobe.
Day 30 ➡
- Rapid Test-PCR (negative).
- The patient was discharged.
Conclusion.
- Pneumomediastinum Spontaneous is generally a self-limiting disease.
- Pneumomediastinum Spontaneous has the potential to cause severe circulatory and respiratory pathology.
- Pneumomediastinum Spontaneous in COVID-19 patients needs to be closely monitored as an indicator of worsening disease.
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