Recurrent pneumomediastinum in a patient with rheumatoid arthritis

Spontaneous pneumomediastinum (SPM); also known as mediastinal emphysema, is a rare and usually benign self-resolving appearance of extraluminal air in the mediastinum without any underlying trigger. This is an uncommon disorder mostly seen in the young males and classic clinical presentation is with chest pain, dyspnea, cough and appearance of subcutaneous emphysema. Although several connective tissue disorders have been reported in association with SPM, it is a rare occurrence in rheumatoid arthritis (RA) with only small number of cases reported in literature. We report a 69 years old male with RA who developed recurrent asymptomatic episodes of SPM detected over a period of one year. The recurrent but benign episodes of SPM in this patient reestablish the usual uncomplicated course of this unusual clinical entity even in the rare recurrent cases.