Severe Respiratory Failure from SARS-CoV-2, Complicated with Pneumothorax in a Pregnant Woman: A Case Report

Najada Como; Nevila Gjermeni; Esmeralda Meta; Dhimiter Kraja; Zamira Hysenaj; Renato Osmenaj; Fadil Gradica; Mirela Rexhepi; Artan Mesi

doi:10.3889/oamjms.2022.8967

Authors

Najada Como Infectious Disease Service, University Hospital Centre “Mother Theresa”, Tirana, Albania
Nevila Gjermeni Infectious Disease Service, University Hospital Centre “Mother Theresa”, Tirana, Albania
Esmeralda Meta Infectious Disease Service, University Hospital Centre “Mother Theresa”, Tirana, Albania
Dhimiter Kraja Infectious Disease Service, University Hospital Centre “Mother Theresa”, Tirana, Albania
Zamira Hysenaj Intensive Care Unit, University Hospital Centre “Mother Theresa”, Tirana, Albania
Renato Osmenaj Radiology Unit, University Hospital Centre “Mother Theresa”, Tirana, Albania
Fadil Gradica Thorasic Surgery Unit, University Hospital of Pulmonary Diseases, Tirana, Albania
Mirela Rexhepi Department of Pharmaceuticals, University Hospital Centre “Mother Theresa”, Tirana, Albania
Artan Mesi National Professional Officer, WHO Country Office, Tirana, Albania

DOI:

https://doi.org/10.3889/oamjms.2022.8967

Keywords:

COVID19, Pregnancy, Pneumothorax, Severe form, Cesarean section

Abstract

Introduction:The first data for COVID-19 in pregnancy showed mild to moderate forms of the disease while current data speaks of severe forms in these subjects. Here we present a case of a severe form of COVID-19 in a gemelar pregnant woman complicated with pneumomediastin and pneumothorax,during her hospital stay, in a late stage of disease.

Case presentation: A 38 year-old multiparous woman was referred to university hospital at 25 weeks of gemelar pregnancy. On admission, the patient presented with signs of moderate respiratory insufficiency, which after 12 hours progressed further to severe ARDS. She tested pozitiv for SARS COV 2 on quantitative real-time polymerase chain reaction. Under these conditions it was decided that the pacient undergo a caesarean section for termination of pregnancy. Remdesivir200 mg/day and tocilizumab 8 mg/kg were administered,based on national guidelines. The patient's fever subsided, but her SpO₂ remained at 94%, even with a 15 L/min oxygen mask. After 12 days the patient complains of a severe back pain and her respiratory condition rapidly worsened,reduced saturations up to 80% being under O2 therapy with facial mask with 15 l/min. Chest CT findings confirmed pneumomediastine and pneumothorax,which deteriorated the patient”s status. Thereafter tube thorakostomy was performed. There was a clinical and ABG analysis parameter”s improvement.The patient was discharged 34 days after cesarean delivery with a proper general health.

Conclusion: Our case highlights even more convincingly the fact that in pregnancy, can be severe to life-threating forms of Covid 19. Pneumothorax and pneumomediastinum are complications that can be encountered even in the late stages of severe forms with COVID 19 in pregnancy. Early diagnosis of these complications is essential in adequate management and treatment to avoid fatal outcome.

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