Spontaneous Pneumo-Mediastinum in a Post-COVID-19 Patient with Systemic Sclerosis

Abstract

Pulmonary involvement is the most common cause of death among patients with systemic sclerosis (SSc). The current coronavirus disease 2019 (COVID-19) is particularly problematic to manage in SSc patients since they may experience a more severe evolution of COVID-19 due to the pre-existent interstitial lung disease (ILD) and the administration of immunosuppressive treatments. In addition, the remarkable radiological similarities between SSc-ILD and COVID-19 complicate the differential diagnosis between these two entities. Herein, we present the first case of spontaneous pneumo-mediastinum in a post-COVID-19 patient with SSc. In our patient, both smoking and pulmonary fibrosis could lead to cyst formation, which possibly spontaneously broke and caused pneumo-mediastinum. Moreover, megaesophagus perforation due to the smooth muscle atrophy, replacement with fibrosis, and achalasia may extend into the mediastinum or pleural space and has also been described as a rare case of spontaneous pneumo-pericardium. Finally, spontaneous pneumo-mediastinum and pneumothorax have been recently reported as an established complication of severe COVID-19 pneumonia and among COVID-19 long-term complication. This case report underlines that the worsening of respiratory symptoms in SSc patients, especially when recovered from COVID-19, requires further investigations for ruling out other tentative diagnoses besides the evolution of the SSc-ILD.

Calcinosis Cutis and Calciphylaxis in Autoimmune Connective Tissue Diseases

“…SSc is a complex autoimmune connective tissue disease affecting the skin, gastrointestinal tract, and lungs, which carries potentially life-threatening complications [ 18 , 19 ]. Microvascular changes with endothelial cell dysfunction, followed by their transition into myofibroblasts, are central in the pathogenesis of the disease [ 20 , 21 ].…”

Eosinophilic Airway Diseases: From Pathophysiological Mechanisms to Clinical Practice

“…In addition, the authors described some common features among COPD patients with eosinophil counts persistently ≥2% (i.e., older age, male gender, fewer current smokers, higher FEV 1 % predicted, higher fat-free mass index, fewer symptoms, and lower BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity index) [ 142 ]. Interestingly, in the ECLIPSE study, although the subjects with high blood eosinophil counts had better clinical characteristics at baseline, they also showed increased rate of emphysema progression, further confirming the pathogenetic role of this cell in airway inflammation, tissue damage, and remodeling [ 142 , 143 ]. In addition, exploring the relationship between lung function and sputum eosinophilia, several studies have shown a link between airway obstruction and eosinophilic lung inflammation.…”

Long COVID in autoimmune rheumatic diseases

“…Systemic sclerosis (SSc) and COVID-19 share radiological signs, complicating the differentiation between these two entities [ 59 ]. It is critically important to timely identify pulmonary changes to prevent severe complications.…”