A 27-Year-Old Woman with an Exacerbation of Chronic Asthma Due to Influenza A Presenting with Pneumomediastinum, Retropharyngeal Emphysema, and Subcutaneous Emphysema

Abstract

Patient: Female, 27-year-old Final Diagnosis: Retropharyngeal emphysema • subcutaneous emphysema • pneumomediastinum Symptoms: Chest pain • shortness of breath • throat pressure Clinical Procedure: — Specialty: Critical Care Medicine • General and Internal Medicine • Pulmonology Objective: Unusual clinical course Background: Influenza infection can trigger an asthma exacerbation, which can lead to spontaneous pneumomediastinum. This is a rare condition that typically occurs after a sudden increase in intra-alveolar pressure. Pneumomediastinum is usually a benign condition that can be treated with supportive care, and it can be accompanied by subcutaneous emphysema. However, it can progress to retropharyngeal emphysema, as reported in this case. This report is of a 27-year-old patient with past medical history of well-controlled asthma presenting for acute exacerbation of asthma secondary to influenza A infection who developed pneumomediastinum, subcutaneous emphysema, and retropharyngeal emphysema. To the best of our knowledge, there is only one case in literature that has reported a similar presentation secondary to influenza A infection. Case Report: We report a 27-year-old woman with well-controlled asthma who presented with chest pain, shortness of breath, throat pressure, dry cough, and expiratory wheezing as an acute exacerbation of asthma secondary to influenza A infection. On chest imaging, she was found to have spontaneous pneumomediastinum, subcutaneous emphysema, and retropharyngeal emphysema. Her symptoms were resolved with supportive measures and control of asthma symptoms. Conclusions: This case highlights these atypical complications of asthma exacerbations. Although these complications are typically benign and can resolve with supportive measures, severe cases can lead to acute airway compromise, pneumothorax, tension pneumomediastinum, or tension pneumopericardium. This case also shows how important it is to consider chest radiographs in any young patient with an asthma exacerbation who has symptoms or signs suggestive of extra-alveolar air.

Spontaneous pneumothorax risk factor mapping: A Mendelian randomization study

“…The present study confirms that there is a positive causal relationship between lymphocyte count height and the occurrence of spontaneous pneumothorax, probably due to the fact that autoimmune and inflammatory diseases mainly invade human lymphocytes [27] , leading to the destruction of the human immune system, which results in the emergence of a variety of opportunistic lung infections and ultimately causes spontaneous pneumothorax. Bronchial asthma [28] is a common clinical condition, and its acute exacerbation is often combined with spontaneous pneumothorax, and the present study also confirms a causal relationship with the occurrence of spontaneous pneumothorax. A study at confirmed that mechanical ventilation in critically ill patients with novel coronavirus pneumonia (COVID-19) [29] had a 5.38% probability of being associated with pneumothorax, and we also confirmed that COVID was positively associated with the risk of spontaneous pneumothorax.…”