Severe pneumomediastinum in an infant with respiratory syncytial virus infection: A case report.

Abstract

Rationale: The respiratory syncytial virus (RSV) is an important cause of bronchiolitis in children, with limited reports of pneumomediastinum as a complication. We report an infant with pneumomediastinum associated with RSV infection requiring intubation.

Patient concerns: A 4-month-old male infant was diagnosed with RSV infection on the 2nd day of symptom onset (coughing and fever). On the 7th day of symptom onset, chest radiography and computed tomography revealed severe pneumomediastinum, and thus, he was transferred to the intensive care unit.

Diagnosis: Severe pneumomediastinum secondary to RSV infection.

Interventions: The patient was intubated, and lung-protective ventilation with muscle relaxants was initiated. After 42 hours of continuous muscle relaxant administration, weaning from mechanical ventilation was started. He was extubated after confirming improved oxygenation and favorable imaging findings.

Outcomes: The infant recovered completely without further worsening of pneumomediastinum.

Lessons: An infant with severe pneumomediastinum requiring intubation during the course of RSV infection was successfully managed with lung-protective ventilation using muscle relaxants.