Caution with Mild COVID19 Pneumonia: A Case of Cavitary Lesions and Pneumothorax in a Young Male with No Past Medical History

Abstract

Introduction: Cavitary lesions have a very broad differential diagnosis. Some case studies have shown COVID19 to cause cavitary lesions1,2 and others have shown COVID19 to cause pneumothorax3. We describe a case report of a young man with no significant past medical history who was hospitalized for COVID19 pneumonia and was subsequently developed a pneumothorax. Case Report: A 39-year-old male presented to the hospital for acute onset shortness of breath. On admission, he was found to have right-sided pneumothorax and a pigtail catheter was placed with a proper expansion of the right lung. Approximately one month previously, he had been admitted for mild COVID19 pneumonia and successfully treated with dexamethasone and was discharged home with stable condition.On further evaluation, chest CT revealed multiple cavitary lesions with one large cavitation in the inferior right upper lobe with prominent mediastinal and hilar nodes. Quantiferon gold, AFB x3, and mycobacterium complex PCR were all negative. Fungitell, 1-3 B-D gluten, and coccioides antibodies were also negative. The patient had no other suggestive features to warrant vasculitis or malignancy evaluation. Discussion:The importance of this case is recognizing the late sequela of COVID19 pneumonia such as cavitary lesions and pneumothorax as seen with our patient. Some studies showed the development of pneumothorax associated with COVID19 but no previous studies showed the development of these findings in a patient without any past pulmonary history3. We attributed the development of cavitary lesions to covid19 and subsequently, because of that, the patient developed pneumothorax. Conclusion: It is important to consider the long term sequela of COVID19 pneumonia especially in those we consider to have mild disease. It is important to minimize potential severe consequences such as pneumothorax which occurred due to intense coughing as seen with our patient.