Spontaneous pneumomediastinum due to paralytic rabies

Abstract

Rabies is a fatal disease resulting from rabies virus infection, causing severe neurological symptoms and ultimately death by destroying the nervous system. In general, a patient tends to see a neurologist or an infectious diseases physician, with very common and typical discipline-related signs and symptoms, such as hydrophobia, aerophobia, and mental disorders. However, we reported a rabies patient who was first admitted to see a thoracic surgeon with spontaneous pneumomediastinum.

Pneumomediastinum and subcutaneous emphysema in a rabid bull

“…(ROSHAN et al, 2003), Mycoplasma pneumoniae (FEARON et al, 2007), Pneumocystis jiroveci (former P. carinii) (MOSS et al, 1995;LEE et al, 2009). On rare occasions, idiopathic pneumomediastinum has been associated with paralytic rabies in people (OMEZZINE et al, 1994;KIETDUMRONGWONG & HEMACHUDHA, 2005;WANG et al, 2013). Idiopathic pneumomediastinum is considered to occur when no specifi c pathophysiological mechanism can be identifi ed.…”

“…In humans, air in the retropharyngeal space and pneumomediastinum can lead to diagnostic misinterpretations, primarily due to the omission of parts of the medical history and symptoms suggestive of rabies (KIETDUMRONGWONG & HEMACHUDHA, 2005). The mechanism of pneumomediastinum is unknown; it might be associated with violent spasms of the pharynx and larynx that cause an acute and temporary obstruction of the airways, leading to alveolar rupture under a brief period of increased pressure (WANG et al, 2013). In cattle, subcutaneous and pulmonary emphysema has been attributed to bellowing in cases of rabies in Southern Africa (SWANEPOEL, 1994), probably due to respiratory effort.…”

“…Most likely, the pneumomediastinum and subcutaneous emphysema resulted from pulmonary alveolar rupture as a consequence of pharyngeal and/ or laryngeal spasms given that the bull experienced severe respiratory diffi culty. In humans, the mechanism of spontaneous pneumomediastinum and subcutaneous emphysema is unclear (WANG et al, 2013). Nevertheless, it has been suggested that uncontrolled pharynx and larynx spasms results in acute and transient obstruction of the airway and esophagus lumen that causes alveolar rupture under transient higher pressure, thereby permitting air to spread elsewhere (MAUNDER et al, 1984).…”