Spontaneous pneumomediastinum in a cocaine user. Case report

Abstract

Introduction: Spontaneous pneumomediastinum is a rare disease. Its clinical course is usually self-limiting and resolves without intervention, except monitoring. However, when complications arise, it can be fatal. Clinical case: We present the case of a 20-year-old male patient who presented spontaneous pneumomediastinum secondary to cocaine use. The clinical picture of 1 day of evolution abruptly evolved into alterations in the state of consciousness, subcutaneous emphysema and respiratory failure that required orotracheal intubation. Diagnosis, interventions, and results: The patient presented spontaneous pneumomediastinum secondary to cocaine use, requiring mechanical ventilation due to altered state of consciousness and respiratory failure. He was hospitalized in the ICU for 31 days, where he also presented AKIN 2 acute kidney injury with resolution without the need for dialysis, in addition to withdrawal syndrome. Two failed extubations were performed secondary to healthcare-associated pneumonia, requiring tracheostomy, which was eventually decannulated for discharge. Conclusion: Spontaneous pneumomediastinum generally has a self-limiting course. The case presented was serious, with a long hospital stay and several complications during hospitalization, but he was discharged clinically stable. POCUS is used for monitoring and treatment of pathology in a resource-limited setting.