Delayed Diagnosis of Community-Acquired Pneumonia-Associated Spontaneous Pneumomediastinum Following Nonspecific Symptoms: A Case Report

Abstract

Pneumonia is a common acute lower respiratory tract infection, whereas pneumomediastinum is an uncommon condition that may present with nonspecific symptoms and be overlooked on initial assessment. We report a 25-year-old male smoker who presented to the emergency department with a three-week history of malaise, fatigue, and loss of appetite, followed in the days before admission by chills, worsening fatigue, productive cough, retrosternal pleuritic chest pain, and nausea. On respiratory examination, fine crackles were auscultated over both upper lobes, with no palpable subcutaneous crepitus. Laboratory tests showed elevated C-reactive protein and leukocytosis. Chest radiography did not demonstrate pneumomediastinum, but computed tomography revealed bilateral upper lobe pneumonia with mediastinal and paracardiac air and cervical subcutaneous emphysema. The patient was managed conservatively with antibiotics, supportive care, analgesia, antiviral treatment, and inhaled therapies. He improved clinically and was discharged without complications or invasive intervention. This case highlights that spontaneous pneumomediastinum may coexist with community-acquired pneumonia and may be overlooked, particularly in patients with prolonged symptoms and subtle initial findings.