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Severe Respiratory Failure from SARS-CoV-2, Complicated with Pneumothorax in a Pregnant Woman: A Case Report

Introduction:The first data for COVID-19 in pregnancy showed mild to moderate forms of the disease while current data speaks of severe forms in these subjects. Here we present a case of a severe form of COVID-19 in a gemelar pregnant woman complicated with pneumomediastin and pneumothorax,during her hospital stay, in a late stage of disease. 
Case presentation: A 38 year-old multiparous woman  was referred to university hospital at 25 weeks  of gemelar pregnancy. On admission, the patient presented with signs of moderate respiratory  insufficiency, which after 12 hours progressed further to severe  ARDS. She  tested pozitiv  for SARS COV 2 on quantitative real-time polymerase chain reaction. Under these conditions it was decided that the pacient  undergo a caesarean section for termination of pregnancy. Remdesivir200 mg/day and tocilizumab 8 mg/kg were administered,based on national guidelines. The patient's fever subsided, but her SpO2 remained at 94%, even with a 15 L/min oxygen mask. After 12 days the patient complains of a severe back pain and her respiratory condition rapidly worsened,reduced saturations up to 80% being under O2 therapy with facial mask with 15 l/min. Chest CT findings confirmed pneumomediastine and pneumothorax,which deteriorated the patient”s status. Thereafter tube thorakostomy was performed. There was a clinical and ABG analysis parameter”s improvement.The patient was discharged 34 days after cesarean delivery with a proper general health. 
Conclusion: Our case highlights even more convincingly the fact that in pregnancy, can be severe to life-threating forms of Covid 19. Pneumothorax and pneumomediastinum are complications that can be encountered even in the late stages of severe forms with COVID 19 in pregnancy. Early diagnosis of these complications is essential in adequate management and treatment to avoid fatal outcome.