A woman in the Netherlands recovered after an apparently mild COVID-19 infection when, suddenly, her two lungs collapsed, according to a new report.
The 38-year-old woman went to the emergency room after experiencing shortness of breath and a sharp pain in her chest, according to the report, published on January 22 in The Journal of Emergency Medicine. She said that her symptoms started suddenly that day and seemed to be getting worse.
Five weeks earlier, the woman had developed symptoms of COVID-19, including fever and muscle pain, and had tested positive for the new coronavirus. At that time, she was able to treat her symptoms at home with acetaminophen and an inhaler. She had gone through an initial period of recovery from her illness, but then her new symptoms started.
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An X-ray in the emergency room showed that she had “bilateral pneumothorax”, that is, both lungs collapsed. A collapsed lung (pneumothorax) occurs when air leaks from the lung into the space between the lung and the chest wall, which presses on the lung and prevents it from expanding properly, according to the National Institute of Health.
The condition can be caused by trauma to the chest or by certain underlying lung diseases, including chronic obstructive pulmonary disease (COPD). Patients who are placed on a ventilator are also at risk of lung collapse because the device can “over-inflate” the lung, according to the University of Wisconsin-Madison.
But the woman’s case was unusual because she had no risk factors for the disease and she had not been hospitalized or placed on a ventilator before her lung collapse, the authors said.
Cases of pulmonary collapse in patients with COVID-19 have been reported before, but mainly in hospitalized patients. A study of approximately 6,500 COVID-19 patients hospitalized in the United Kingdom, published in September 2020 in The European Respiratory Journalfound that about 1% of these individuals had pneumothorax. Of the 60 patients described in the study as having pulmonary collapse, most received some type of ventilatory support, but one third did not. Only four patients had pneumothorax in both lungs.
The authors of the new report, from the Elisabeth TweeSteden Hospital in the Netherlands, concluded that emergency physicians should be aware of pneumothorax as a possible “delayed complication related to COVID-19.”
The cause of the woman’s lung collapse is unclear. (When doctors are unable to identify the cause of a collapsed lung, this is known as a “spontaneous” collapsed lung.) The authors cannot say with certainty that COVID-19 caused the woman’s lung collapse – the timing may have been coincidental, they said. But given that the woman had no other risk factors for lung collapse, COVID-19 may have played a role. For example, the infection may have caused microscopic changes in the tissue and blood vessels in the lungs that eventually resulted in pneumothorax, the authors said.
Doctors usually treat the pneumothorax by inserting a needle-shaped instrument into the ribs to remove excess air around the patient’s lungs, according to the Mayo clinic. In the case of the woman, doctors used this instrument to remove air around the right lung. His left lung was not treated because only a small part of it had collapsed and his doctors thought it would probably heal on its own. In fact, four weeks later, her two lungs expanded back to normal size and she had no other pulmonary complications, the report said.
Originally published on Live Science.