Tension Pneumomediastinum in Anti-MDA5 Antibody-positive Dermatomyositis-associated Interstitial Lung Disease: A Case Report and Literature Review

Hiroko Okabayashi; Seiya Nakashima; Kosuke Fujino; Miyu Imai; Shohei Hamada; Aiko Masunaga; Hidenori Ichiyasu; Makoto Suzuki; Takuro Sakagami

doi:10.2169/internalmedicine.3418-23

Hiroko Okabayashi, Seiya Nakashima, Kosuke Fujino, Miyu Imai, Shohei Hamada, Aiko Masunaga, Hidenori Ichiyasu, Makoto Suzuki, Takuro Sakagami

Author information

Hiroko Okabayashi
Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life, Sciences, Kumamoto University, Japan
Seiya Nakashima
Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life, Sciences, Kumamoto University, Japan
Kosuke Fujino
Department of Thoracic Surgery, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Japan
Miyu Imai
Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life, Sciences, Kumamoto University, Japan
Shohei Hamada
Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life, Sciences, Kumamoto University, Japan
Aiko Masunaga
Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life, Sciences, Kumamoto University, Japan
Hidenori Ichiyasu
Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life, Sciences, Kumamoto University, Japan
Makoto Suzuki
Department of Thoracic Surgery, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Japan
Takuro Sakagami
Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life, Sciences, Kumamoto University, Japan

Keywords: anti-MDA5 antibody, dermatomyositis, interstitial lung disease, tension pneumomediastinum

JOURNAL OPEN ACCESS Advance online publication

Article ID: 3418-23

DOI https://doi.org/10.2169/internalmedicine.3418-23

Details

Abstract

Anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (DM)-associated interstitial lung disease (ILD) can sometimes be complicated by pneumomediastinum, although tension pneumomediastinum is extremely rare. We herein report a case of anti-MDA5 antibody-positive DM-ILD that worsened subcutaneous and mediastinal emphysema during treatment. Hypotension and worsening respiratory failure were observed on day 20 of treatment. Mediastinal drainage under video-assisted thoracoscopic surgery promptly improved the patient's circulatory and respiratory status. Tension pneumomediastinum is a rare complication; however, it is a serious condition that may lead to hypotension or cardiac arrest and requires a prompt diagnosis and treatment.

Corresponding author

Register with J-STAGE for free!