Spontaneous Pneumomediastinum Following Ingestion of Bleach, Dish Soap, and Laundry Detergent and Inhalation of Methamphetamines.

Abstract

Introduction: Spontaneous pneumomediastinum (SPM) is a rare condition defined by the presence of air in the mediastinum in patients without an observable traumatic cause. Pneumomediastinum is a somewhat rare condition that occurs 1 in every 25 000 individuals, aged 5 to 34 years old, with 76% occurring in men. Pneumomediastinum can further be divided into 2 categories: SPM and traumatic pneumomediastinum. Traumatic pneumomediastinum is most commonly seen with blunt force trauma or any iatrogenic procedures to the chest wall. Spontaneous pneumomediastinum frequently occurs due to air leaking through small alveolar sacs, which rupture within the surrounding bronchovascular sheath. Spontaneous pneumomediastinum can be further divided into primary and secondary causes; the main difference is that secondary SPM requires a preexisting condition (ie, lung disease). Primary SPM is considered when trauma or any iatrogenic causes are ruled out. Secondary SPM, which is more common, is usually seen with esophageal perforation. Few case reports have been published connecting the inhalation of marijuana, cocaine, and the use of opioids to SPM, and, until now, no published data links the ingestion of cleaning products to SPM.

Case presentation: This case report presents a 28-year-old White man who developed a SPM following the ingestion of bleach, dish soap, and laundry detergent and the inhalation of methamphetamines. This case report highlights the potential for chemical-induced pneumomediastinum and emphasizes the importance of considering unusual etiologies in patients presenting with acute chest pain and respiratory distress after chemical exposures with a suicide attempt.

Conclusion: Spontaneous pneumomediastinum is due to a pressure change within the thoracic cavity as a result of air leakage. This has been commonly seen with certain risk factors, such as cystic fibrosis, chronic obstructive pulmonary disease, and, most commonly, Boerhaave's syndrome. However, there are other less commonly known risk factors that can predispose a patient to or contribute to them developing SPM, including methamphetamine use and inhalation of laundry chemicals.