A challenging case of pneumothorax in a COVID-19 pneumonia patient. Can fresh frozen plasma pleurodesis be an effective treatment?

The emerging novel coronavirus SARS-CoV-2 and the corresponding disease COVID-19 is undoubtedly one of the most discussed public health issues at the moment. The primary manifestation of COVID-19 is in most cases that of a mild respiratory infectious disease. Still, COVID-19 has the potential to progress to severe viral pneumonia, respiratory failure and a catastrophic cytokine-release-like systematic inflammatory syndrome [1]. After the diagnosis and initial management of COVID-19 patients, the treating physicians must shift their attention to the severe complications accompanying the disease. Among these, and perhaps one of the less reported in literature, is the occurrence of secondary spontaneous pneumothorax (SSP) as a result of severe lung tissue damage. On 24/8/2021, a 78-year-old man presented at the Emergency Department of our institution, complaining of sudden severe dyspnea, and reporting malaise as well as dry cough for the past 3 days. The patient’s past medical history included diabetes mellitus and primary hypertension, for which he was treated with metformin and lisinopril. The patient was a past smoker who had quit smoking for the past 7 years. The first vaccination dose of the Pfizer–BioNTech COVID-19 vaccine was also administered to the patient, only a few days prior, on 19/08/2021. On physical examination, the patient appeared distressed, dyspneic and tachypneic. Respiratory rate was 30 breaths/min with O2 saturation of 89% on room air and febrile with a temperature of 38.5°C. The rest of the vital signs were found to have normal values: heart rate of 80 bpm, blood pressure of 125/73 mm Hg. Examination of the respiratory system revealed diffuse rales at the lower and middle pulmonary fields on auscultation. The rest of the physical examination was unremarkable. Laboratory examinations of the patient included a rapid antigen test for SARS-CoV-2 infection, due to the classification of the patient’s presentation as probable COVID-19 pneumonia, in accordance with the current national guidelines. The nasopharyngeal swab of the patient tested positive, and he was subsequently placed within the high-dependency unit (HDU), on high-flow nasal cannula (HFNC) oxygen therapy, and closely monitored for further deterioration that would require immediate invasive respiratory support. Arterial blood gas testing revealed a partial O2 pressure of 58.9 mm Hg, indicating impending respiratory failure. Laboratory tests also revealed CRP levels of 2.72...


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