Case Report
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Clin Cases. Oct 16, 2013; 1(7): 224-226
Published online Oct 16, 2013. doi: 10.12998/wjcc.v1.i7.224
Pneumomediastinum, pneumorachis, subcutaneous emphysema: An unusual complication of leukemia in a child
Hakim Irfan Showkat, Aleem Jan, Arif Hussain Sarmast, Gull Mohammad Bhat, Basharat Mujtaba Jan, Yasir Bashir
Hakim Irfan Showkat, Aleem Jan, Arif Hussain Sarmast, Gull Mohammad Bhat, Basharat Mujtaba Jan, Yasir Bashir, Department of Internal Medicine, Sheri-Kashmir Institute of Medical Sciences, Srinagar Kashmir 190001, India
Author contributions: Showkat HI contributed to the primary work up and management; Jan A contributed to guiding the management and leukemia treatment; Sarmast AH contributed to the neurosurgical management; Bhat GM contributed to the leukemia management and writing; Jan BM helped in neurosurgical management and Bashir Y helped in complication management.
Correspondence to: Hakim Irfan Showkat, Post Graduate, Department of Internal Medicine, Sheri-Kashmir Institute of Medical Sciences, Nohata, Srinagar Kashmir 190001, India. docirfanshahi512@gmail.com
Telephone: +91-94-19028326 Fax: +91-94-2425338
Received: March 1, 2013
Revised: August 12, 2013
Accepted: August 17, 2013
Published online: October 16, 2013
Processing time: 226 Days and 17.6 Hours
Abstract

Pneumorrhachis (PR), or epidural emphysema, denotes the presence of air in the spinal epidural space. It can be associated with a variety of etiologies, including trauma; recent iatrogenic manipulations during surgical, anesthesiological and diagnostic interventions; malignancy and its associated therapy. It usually represents an asymptomatic epiphenomenon but also can be symptomatic by itself, as well as by its underlying pathology, and rarely can be fatal. The pathogenesis and etiology of PR are varied and can sometimes be a diagnostic challenge. As such, there are no standard guidelines for the management of symptomatic PR and its treatment is often individualized. Here, we present a case of a 14-year-old boy treated for leukemia who developed this complication and whether chemotherapy related or not, it proved to be fatal for him. To our knowledge, this is the first case in the literature of this complication with acute lymphoblastic leukemia.

Keywords: Pneumomediastinum; Leukemia; Pneumorachis; Subcutaneous emphysema; Chemotherapy

Core tip: Pneumomediastinum, pneumorachis, subcutaneous emphysema is anunusual complication in leukemia. Although not mentioned in literature, this case may be an eye opener to look for this complication in this scenario. Acute lymphoblastic leukemia (ALL) is not mentioned as a cause of this condition but medical science has always made us learn from case to case. This case may be an index for this complication as all mentioned secondary causes were ruled out by all available investigations. Whether it is related to chemotherapy or not, it is definitely a case of ALL with this complication.