ABSTRACT
Background: Development of spontaneous pneumothorax and pneumomediastinum is one of the complication of COVID-19 viral pneumonitis. This has been described in both mechanically ventilated patients or on non invasive/ high flow nasal cannula oxygen support. The Macklin effect can been proposed as a possible etiology owing to the propensity to the damage to type2 pneumocytes, alveolar rupture secondary to direct alveolar injury. Case: 32 year male, non smoker, non alcoholic with no comorbidities presented to emergency with sudden onset of shortness of breath, left chest pain. HRCT chest done showed left pneumothorax with mediastinal shift. Intercostal drainage tube(ICD) was placed on the left side and patient was stabilised. Patient has had similar complaints one week back for which right sided ICD was placed. Patient had history of COVID-19 infection one month back. He did not require any supplemental oxygen or ventilatory support. Right side ICD was removed 1 week later as there was no air leak. Left side had persistent air leak, with non expanding lung. Patient was put on supplemental oxygen. He was treated with antibiotics, other supplemental oxygen and repeat HRCT chest showed loculated hydropneumothorax with bronchopleural fistula (BPF) on the left side. The patient was discharge with ICD. After improving the general condition, the air leak was surgically corrected with left lobe decortication and BPF closure. Conclusion: COVID 19 infection renders more propensity to damage type 2 pneumocytes. The alveolar rupture is secondary to alveolar injury causing increased tendency for air leak without obviously increased pressures.