Introduction: Spontaneous pneumomediastinum (SPM) is uncommon, benign, and self-limiting disease based on the presence of free air in the mediastinal cavity. It often occurs after a forced Valsalvas maneuver due to a cough, emesis or during an asthma exacerbation.
Case Presentation: We present a 4-month-old girl infant with an autoimmune hemolytic anemia and lymphopenia, who was admitted to the pediatric intensive care unit (PICU) due to respiratory distress. A suspected pneumomediastinum (PM) image on chest x-ray was documented by the chest tomography. A polymerase chain reaction (PCR) of the nasopharyngeal secretions was positive for a respiratory syncytial virus (RSV) and human bocavirus (HBoV). Additionally, she was examined for an immune deficiency due to her lymphopenia. The patient required mechanical ventilatory support for 26 days. She was treated with antibiotics, antiviral, and antifungal agents and corticosteroids (CSs). Intravenous immunglobulin (IVIG), trimethoprim sulfamethoxazole (TMP-SMX), and fluconazole prophylaxis were continued because of the ongoing lymphopenia. At the end of five weeks, the patient was discharged with a normal lymphocyte count and without any respiratory distress.
Conclusion: In immunosuppressed patients, respiratory diseases may be severe and long. Therefore, complications including pneumomediastinum can be seen more frequently in this group of patients.
Key words: Human bocavirus, immundeficiency, respiratory syncytial virus, rituximab, spontaneous pneumomediastinum
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