RESUMEN
To our knowledge, Complications such as pneumomediastinum and/or pneumothorax during the course of COVID-19 remain rare and their mechanism is poorly described. We present a case of COVID-19 pneumonia associated with spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in an immunocompetent patient with no past history of smoking or chronic obstructive pulmonary disease (COPD). The only risk factor of this patient was prolonged cough. We hypothesize the mechanism underlying the pneumomediastinum is the aggressive disease pathophysiology in COVID-19 with an incresead risk of alveolar damage.
RESUMEN
INTRODUCTION: No therapy has yet proven effective in COVID-19. Tocilizumab (TCZ) in patients with severe COVID-19 could be an effective treatment. METHOD: We conducted a retrospective case-control study in the Nord Franche-Comté Hospital, France. We compared the outcome of patients treated with TCZ and patients without TCZ considering a combined primary endpoint: death and/or ICU admissions. RESULTS: Patients with TCZ (n=20) had a higher Charlson comorbidity index (5.3 [±2.4] vs 3.4 [±2.6], P=0.014), presented with more severe forms (higher level of oxygen therapy at 13L/min vs 6L/min, P<0.001), and had poorer biological findings (severe lymphopenia: 676/mm3 vs 914/mm3, P=0.037 and higher CRP level: 158mg/L vs 105mg/L, P=0.017) than patients without TCZ (n=25). However, death and/or ICU admissions were higher in patients without TCZ than in the TCZ group (72% vs 25%, P=0.002). CONCLUSION: Despite the small sample size and retrospective nature of the work, this result strongly suggests that TCZ may reduce the number of ICU admissions and/or mortality in patients with severe SARS-CoV-2 pneumonia.