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Case Reports
. 2017 Mar;29(91):113-116.

Subcutaneous Emphysema, Pneumomediastinum and Pneumothorax in a Patient with Dermatomyositis

Mehdi Bakhshaee  1 , Mohammad Hassan Jokar  2 , Zahra Mirfeizi  2 , Elham Atabati  2 , Somayeh Tarighat  2
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Free PMC article
Case Reports

Subcutaneous Emphysema, Pneumomediastinum and Pneumothorax in a Patient with Dermatomyositis

Mehdi Bakhshaee et al. Iran J Otorhinolaryngol. 2017 Mar.
Free PMC article

Abstract

Introduction: Spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema are rare, but serious complications of inflammatory myopathies and occur more commonly in DM than PM. complications of dermatomyositis (DM) and polymyositis (PM), both of which can be fatal.

Case report: A 20-year-old woman was admitted with neck pain, dyspnea, cough, and fever. She had been diagnosed with dermatomyositis 21 months prior. A thorax computed tomography (CT) scan revealed ground glass opacities in her lungs, pneumomediastinum, pneumothorax, and subcutaneous emphysema. Despite intensive immunosuppressive therapy, clinical deterioration and radiological progression were observed, ultimately the patient died.

Conclusion: During the care for a patient with dermatomyositis, the otorhinolaryngologist should be cautious of rapidly progressive and fatal neck subcutaneous emphysema. For a patient with dermatomyositis and with normal bronchoscopy and esophagoscopy, the main treatment is control of dermatomyositis with medical therapy. Therefore, a tracheostomy and/or mechanical ventilation may not be necessary.

Keywords: Dermatomyositis; Pneumomediastinum; Pneumothorax; Polymyositis; Subcutaneous emphysema.

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Figures

Fig1
Fig1
Chest radiograph showing bilateral interstitial and reticulonular changes
Fig 2
Fig 2
Chest computed tomography scans showing subcutaneous emphysema, pneumomediastinum, pneumothorax, thickening of interlobular septa, and a reticulonodular pattern
Fig 3
Fig 3
Computed tomography scan of paranasal sinuses showing emphysema in parietal, temporal, and occipital soft tissue and retropharyngeal space
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