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Introduction: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2. It typically presents with respiratory symptoms such as fevers, cough, and shortness of breath. As the number of cases increases, however, COVID-19 is being increasingly recognized as being associated with a variety of other respiratory pathologies. Case Report: We present the case of a 59-year-old man with COVID-19 pneumonia who acutely decompensated after having been on the medicine floor for two weeks. He was found to have a tension pneumothorax. This was treated with a needle decompression followed by a chest tube insertion. The patient subsequently recovered and was discharged. Conclusion: This case highlights the importance of considering tension pneumothorax as a possible cause of shortness of breath in patients with COVID-19 pneumonia.

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Delusional parasitosis is an uncommon psychiatric disorder that manifests as having parasitic delusions. Due to its rarity, delusional parasitosis is a challenging and costly diagnosis of exclusion and proves difficult to manage for many providers. Although this syndrome is frequently discussed in psychiatric and dermatology reports, it is not commonly described in emergency medicine (EM) literature. As a result, best practices for workup and treatment remain unclear from an EM perspective. Patients typically return multiple times for medical evaluation and exhaust numerous resources. In this case report we review the appropriate steps for initial evaluation of patients with suspected delusional parasitosis, differential diagnoses, and increase awareness for prudent treatment strategies.