Unexpected Pneumomediastinum in Crohn's Disease: Implications and Case Analysis

BACKGROUND Inflammatory bowel disease is commonly associated with recurrent abdominal pain and bloody diarrhea, with or without systemic involvement. Here, we report a very rare presentation of inflammatory bowel disease with pneumomediastinum, which is important for healthcare workers to be aware of because pneumomediastinum can present with rapid symptoms onset. Previous reported cases were mainly noted after long-term steroids use or scope-induced perforation. CASE REPORT We present a case a 23-year-old woman with a 14-day history of constipation followed by diarrhea (sometimes bloody), with vomiting, abdominal pain, and fever. She was initially managed as having acute gastroenteritis, but due to persist unexplained tachycardia, a chest CT was done, which incidentally showed a pneumomediastinum along with pulmonary embolism. The patient deteriorated significantly on the same day of chest imaging and developed severe lactic acidosis with hypoglycemia and severe hepatic injury. After extensive assessment by imaging and scopes for biopsy, she was diagnosed with fulminant Crohn's disease, causing severe liver injury, colitis, and pneumomediastinum. She improved significantly with steroids and was discharged home. On follow-up, immunosuppressive agents were initiated. CONCLUSIONS Pneumomediastinum is a rare manifestation of inflammatory bowel disease, which could be reflective of severe colitis and should be considered in patients presenting with chest symptoms regardless of procedure, scope exposure, or long-term steroids use. Attention to early instability signs like tachycardia and tachypnea can help reveal early complications.