Neumotórax recidivante en paciente sin factores de riesgo y la posible asociación con COVID-19

Abstract

Since the start of the COVID-19 pandemic, the most common clinical presentation in pediatric population is characterized by typical respiratory symptoms such as dry cough, mild dyspnea, and radiological findings with less lobar compromise than  adults. In children, depending on etiology, pneumothorax is classified as spontaneous, (primary or secondary) and traumatic. Primary spontaneous pneumothorax usually appears in previously healthy patients and usually results from the rupture of a subpleural bulla. Secondary spontaneous pneumothorax is caused by complication of underlying lung disease, and pneumothorax due to trauma can be caused by a wide range of lung or airway injuries, including central venous catheterization, thoracocentesis in hospitalized patients, etc. Cases associated with COVID-19 have been described in patients without predisposing factors, although their pathophysiology is still unclear. We now present a patient with recurrent spontaneous pneumothorax and possible association with SARS-CoV-2 infection, in August 2021, who did not meet the criteria for any of the known causes.

A 14-year-old female patient consulted referring 2 weeks of persistent coughing, mild pain in the left parasternal region, and mild intermittent dyspnea. Medical history: previously healthy patient with no relevant history, who had COVID-19 on 07-09-2021 with mild symptoms (3-day fever, mild cough, mild dyspnea). On physical examination, the patient was eutrophic, vesicular murmur (vm) decreased in the upper region of the left lung field, pulse oximetry 96%, hemodynamically stable. Chest x-ray: image compatible with pneumothorax in the apical region of the left lung. Chest CT: massive pneumothorax. Surgical drainage is performed with discharge 7 days after hospitalization. On the 13th day after discharge, patient consults due to fainting, mild dyspnea, and sudden oppressive pain in the left hemithorax; VM was abolished in vertex and middle zone of left lung field; Chest CT scan: subpleural bulla at the apex of left lung. Surgical resection was performed by video-assisted thoracoscopy with definitive discharge after 8 days.

This case is presented to report the development of recurrent pneumothorax in the absence of predisposing factors and in relation to recent SARS-CoV-2 infection, which suggests a possible connection with cytopathic effects produced by the infection at a pulmonary level.