# Case Report: Re-expansion pulmonary edema following a pneumothorax drainage in a patient with H1N1 and Mycoplasma pneumoniae co-infection

## TL;DR

A young man with H1N1 and Mycoplasma pneumonia developed severe lung complications after pneumothorax drainage, highlighting risks in mixed infections.

## Contribution

This case report highlights the risk of re-expansion pulmonary edema in mixed viral-bacterial lung infections, even in previously healthy young patients.

## Key findings

- A 20-year-old male with H1N1 and Mycoplasma pneumonia developed RPE after pneumothorax drainage.
- Mixed infections may increase lung fragility and complicate pneumothorax healing.
- Early surgical intervention was necessary despite preventive measures.

## Abstract

Re-expansion pulmonary edema (RPE) represents a rare but potentially fatal complication that can occur subsequent to pneumothorax drainage or pleural effusion. Currently, there is a limited understanding of its underlying pathogenesis and associated risk factors. Co-infection with Mycoplasma pneumoniae and influenza A (H1N1) virus, although rare, may exacerbate lung injury and complicate clinical prognoses.

Herein, we report a case of a 20-year-old male with no prior significant medical history. The patient presented with fever and chest tightness and was subsequently diagnosed with H1N1 influenza, Mycoplasma pneumoniae pneumonia, and right-sided massive spontaneous pneumothorax. Despite the implementation of early closed thoracic drainage with preventive measures against RPE, the patient developed RPE and refractory pneumothorax, ultimately requiring thoracoscopic surgical intervention. Notably, invasive mechanical ventilation was not required, and the patient achieved a full recovery following intensive care management.

This case underscores the intricate pathophysiological interplay between viral and atypical bacterial co-infection. These interactions contribute to the fragility of the lung parenchyma, facilitate the development of pneumothorax, impede the healing process, and potentially elevate the risk of RPE. Notably, even in young patients who are not ventilated and have no pre-existing lung disease, severe pulmonary complications can emerge rapidly in the setting of mixed infections.

Clinicians should remain a high level of vigilance for refractory pneumothorax and RPE (recurrent pneumothorax with empyema, assuming this is the correct expansion; if not, replace accordingly) in patients presenting with complicated pulmonary infections. Special attention should be directed toward young patients who were previously in good health and have a relatively short disease duration. Meticulous drainage strategies, close surveillance, and early contemplation of surgical intervention are of utmost importance for optimizing patient outcomes. There is a pressing need for further high-quality research to refine prevention guidelines and enhance the management of RPE in intricate clinical scenarios.