COVID-19 infection with serial bilateral pneumothoraces

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is most frequently associated with a mild presentation of fever, cough, and shortness of breath. Typical radiographic findings in severe COVID-19 infection are bilateral ground-glass opacities on computed tomography (CT) scans. Bilateral pneumothorax is a rare complication of COVID-19. Among observational studies, the incidence of pneumothorax is low at 0.3% in hospitalized COVID-19 patients. However, the incidence of pneumothorax increases to 12.8–23.8% in patients requiring invasive mechanical ventilation.

Case: This case report describes a previously healthy 52-year-old man who had recurrent pneumothoraces. He had five separate episodes of bilateral pneumothoraces during a two-month infection with SARS-CoV-2 during which he required mechanical ventilation. Chest x-rays revealed pneumothoraces, and bilateral chest tubes were inserted into the intrathoracic space for drainage five times. This case highlights the potential atypical clinical course in a COVID-19 infection and is the first reported case, to our knowledge, that features five bilateral spontaneous recurring pneumothoraces.

Conclusion: COVID-19-related pneumothorax is likely a sequela of COVID-19 disease progression due to the inflammatory insult from COVID-19 infection and the increased respiratory effort needed to maintain gas exchange. COVID-19- related pneumothoraces are associated with mechanical ventilation and resolved in prolonged hospitalization. The treatment of COVID-19 and its long-term consequences represents a relatively new challenge for clinicians and health care providers. A multidisciplinary approach during the posthospitalization management of COVID-19 survivors is strongly advised.

Keywords: SARS-CoV-2 infection, COVID-19 lung complications, pneumothorax