Atypical presentation of COVID-19 in a patient with spontaneous pneumothorax and pleural effusion: a case report

Common COVID-19 symptoms include fever, cough, myalgia, and fatigue, with various complications possible. Pleural effusion and pneumothorax are rare and infrequently co-occur. These complications usually appear in hospitalized patients and often signal a poor prognosis. This report examines an 82-year-old male with severe abdominal pain, mild cough, and runny nose. Abdominal CT showed a small to intermediate right pleural effusion and a small left pneumothorax. Chest CT confirmed these findings and interstitial infiltrates. He tested positive for COVID-19. Treatment involved ceftriaxone (2 g), dexamethasone (6 mg), and remdesivir (100 mg); no chest tube or thoracentesis was required. By the 4th day, chest CT showed resolved pneumothorax and pneumonia, with the pleural effusion unchanged. On the 7th day, after completing a five-day remdesivir course, he was stable and discharged. This case suggests pleural effusion and spontaneous pneumothorax can co-occur in early COVID-19 without severe respiratory symptoms and are not always indicative of a poor prognosis.