Subcutaneous Emphysema and Spontaneous Pneumomediastinum in Systemic Lupus Erythematosus and Dermatomyositis Overlap Syndrome

Abstract

with a 5-day history of dry cough, persistent dyspnea on exertion, and mild anterior chest pain on inspiration. She developed liquid diarrhea 5 times daily, 3 days prior to admission. A syncopal episode occurred the day of admission. Medical history revealed an overlap syndrome diagnosed 3 months earlier, systemic lupus erythematosus (SLE) with Raynaud phenomenon, arthritis, malar rash, alopecia, renal and lung involvement (interstitial lung disease [ILD] with nonspecific interstitial pneumonitis pattern), and dermatomyositis (DM) with heliotrope, Gottron papules, Gottron sign with some ulcers (Fig. 1), severe proximal muscle weakness, anemia, lymphopenia, antinuclear antibody positivity at 1/80, anti-dsDNA at 172.3 IU, elevated creatine phosphokinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, aldolase, and proteinuria at 3.5 g/day. High-resolution computed tomography of the chest revealed diffuse FIGURE 1. Clinical features at diagnosis. A and B, Gottron sign with ulcers in elbows and knees. C, Cutaneous vasculopathy in palms. E, Gottron papules in metacarpal phalanges.

Persistent spontaneous pneumomediastinum in a dog with pulmonary fibrosis

“…4,10,11 While the majority of cases of SPM are short-lived (<2 weeks), there are uncommon reports of persistent SPM in people, mostly with underlying immune-mediated disease. 8,9,19 In these instances, duration of clinical signs has been described to occur up to 12 months. 8 One case report describes an adult female with a history of rheumatoid arthritis and associated interstitial pulmonary fibrosis with SPM of 2-month duration.…”

“…While the majority of cases of SPM are short‐lived (<2 weeks), there are uncommon reports of persistent SPM in people, mostly with underlying immune‐mediated disease 8,9,19 . In these instances, duration of clinical signs has been described to occur up to 12 months 8 .…”