Spontaneous Pneumomediastinum as the presenting sign of Mycoplasma pneumoniae infection

  • Ângela Pereira Pediatric Service of Hospital de Braga
  • Catarina Faria Pediatric Service of Hospital de Braga
  • Susana Carvalho Unidade de Adolescentes, Serviço de Pediatria, Hospital de Braga
  • Teresa Pontes Adolescents Unit of Pediatric Service of Hospital de Braga
  • Ana Antunes Unidade de Adolescentes, Serviço de Pediatria, Hospital de Braga
  • Henedina Antunes Pediatric Service of Hospital de Braga; Instituto de Investigação em Ciências da Vida e Saúde; Escola de Ciências da Saúde, Universidade do Minho; Laboratório Associado ICVS/3B’s
  • Sofia Martins Adolescents Unit of Pediatric Service of Hospital de Braga
Keywords: chest pain, Mycoplasma pneumoniae, pneumomediastinum, subcutaneous emphysema

Abstract

Introduction: Spontaneous pneumomediastinum (SP) results from nontraumatic mediastinal air leakage. It is uncommon in children requiring a high index of suspicion.

Case Report: A 17-year-old tall thin boy, light smoker, with no history of trauma or lung disease presented to our emergency room with symptoms dominated by chest pain and mild dyspnea. He reported a violent cough event in the previous hours. Pneumomediastinum was suspected considering the presence of subcutaneous air in the supraclavicular region, and was confirmed by chest radiograph, which showed mediastinal air. Serology study was positive for Mycoplasma pneumoniae and therefore a macrolide was added to symptomatic treatment, with a complete recovery.

Discussion/Conclusion: SP is a diagnosis to consider when facing an adolescent with acute chest pain. This condition is possibly underdiagnosed, given its benign course and mild symptoms. Smoking acts as a predisposing factor. SP has only exceptionally been described in Mycoplasma infection.

References

Avaro JP, D’Journo XB, Hery G, Marghli A, Doddoli C, Peloni JM, Miltgen J, Bonnet D. Pneumomédiastin spontané du jeune adulte: une entité clinique bénigne. Rev Mal Respir. 2006 Feb;23(1 Pt 1):79-82.

E. Bodart, G. de Bilderling, J.F. Nisolle, J.P. Trigaux, D. Tuerlinckx. Pneumomédiastin spontané chez un adolescent: une cause sous-estimée de douleurs thoraciques. Arch Pédiatr. 1999;6:1293-6.

Chalumeau M, Le Clainche L, Sayeg N, Sannier N, Michel JL, Marianowski R, Jouvet P, Scheinmann P, de Blic J. Spontaneous pneumomediastinum in children. Pediatr Pulmonol. 2001 Jan;31(1):67-75.

Ammar A Saadoon, Ibrahim A Janahi. Spontaneous pneumomediastinum in children and adolescents. Setembro, 2014. (Acedido em 15 de Outubro de 2014). Disponível em http://www.uptodate.com.

Dori F Zaleznik, Jesus G Vallejo. Mycoplasma penumoniae infection in children. Junho, 2015. (Acedido em 11 de junho de 2015). Disponível em http://www.uptodate.com.

Okposio MM, Unior MO. Pneumomediastinum and subcutaneous cervical emphysema: unusual complications of childhood pneumonia. Niger J Paed 2014; 41 (1):81–3.

Vázquez JL, Vázquez I, González ML, García-Tejedor JL, Repáraz A. Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia. Pediatr Radiol. 2007;37:1286-8.

Fearon D, Hesketh EL, Mitchell AE, Grimwood K. Mycoplasma pneumoniae infection complicated by pneumomediastinum and severe mucositis. J Paediatr Child Health. 2007 May;43(5):403-5.

Dunn JJ, Malan AK, Evans J, Litwin CM. Rapid detection of Mycoplasma pneumoniae IgM antibodies in pediatric patients using ImmunoCard Mycoplasma compared to conventional enzyme immunoassays. Eur J Clin Microbiol Infect Dis. 2004 May;23(5):412-4.

Semedo FHMA, Silva RS, Pereira S, Alfaiate T, Costa T, Fernandez P et al. Pneumomediastino espontâneo: relato de um caso. Rev Assoc Med Bras 2012; 58(3):355-7.

L. Bonnard, V. Lemaire, M.A. Radermecker, B. Ghaye, R. Limet. Image du mois. Le pneumomédiastin spontané. Rev Med Liege 2006; 61:2:65-6.

Kliegman RM, Stanton BF, St. Geme J, Schor N, Behrman RE. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders Elsevier; 2011: chap 406, p. 1512-3.

B. Petitprez, G. Temgoua, E. Breitkopf, C. Vervel. Pneumomédiastin spontané chez un adolescent: place des examens complémentaires. Annales françaises de médecine d’urgence. 2011; 1(6):415-7.

Published
2015-12-15
How to Cite
Pereira, Ângela, Faria, C., Carvalho, S., Pontes, T., Antunes, A., Antunes, H., & Martins, S. (2015). Spontaneous Pneumomediastinum as the presenting sign of Mycoplasma pneumoniae infection. NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, 24(4), 174-178. https://doi.org/10.25753/BirthGrowthMJ.v24.i4.8485
Section
Case Reports