Spontaneous Pneumothorax in a Child with COVID-19

Abstract

Introduction: SARS-CoV2 (COVID-19) is a serious and global infection that has spread to numerous countries, including Iran. Pneumothorax may occur in cases of COVID-19 as a consequence of lung parenchymal damage, which can disrupt the healing process and increase mortality. Case Presentation: This manuscript describes the case of a 2-year-old boy with hyper IgM syndrome and COVID-19 infection. The patient developed spontaneous pneumothorax and recovered without chest tube by supportive care and was discharged in good general condition after the completion of the antibiotic course and cessation of fever. Conclusions: The severity, prognosis, and best treatment for spontaneous pneumothorax in COVID-19 infection, especially in children, remain nebulous. It is recommended that conservative treatment be performed if the patient has stable vital signs and no severe respiratory failure. However, this requires more detailed clinical evaluations.

Bilateral Spontaneous Pneumothorax in a Child with Multisystem Inflammatory Syndrome Associated with COVID-19

“…A systematic review of 37 articles on CT features in pediatric COVID-19 patients found only two cases of pneumothorax and one case of bullae, none of which was bilateral (10). Hashemi et al (12) described a two-year-old boy with hyper IgM syndrome and COVID-19 infection who developed unilateral spontaneous pneumothorax during the hospital stay. Also, Montgomery et al ( 13) described a 17-year-old boy with COVID-19 infection who presented with unilateral hemopneumothorax, which was exacerbated during the hospital stay.…”

“…Our case did not receive any ventilation supports before pneumothorax diagnosis, reflecting that barotrauma could not be the cause of pneumothorax. Interestingly, in all similar cases (11)(12)(13)(14), barotrauma was also ruled out. One plausible explanation might be excessive coughing, which is common in COVID-19 patients.…”

“…Spontaneous pneumothorax can occur in people without (primary type) or with (secondary type) a pre-existing chronic lung disease or positive history of trauma (7). Although several cases of spontaneous pneumothorax are reported in COVID-19, mostly elderly male patients with underlying conditions (8,9); it is even rarer in pediatric COVID-19 patients (10) presented in a few case reports (11)(12)(13)(14). Moreover, bilateral spontaneous pneumothorax is reported much less than unilateral cases (11,14,15).…”