A 23-year-old male developed spontaneous pneumomediastinum — air trapped in the chest cavity around the heart — after losing 80 kilograms in seven months, according to a case report published in Eating and Weight Disorders – Studies on Anorexia, Bulimia and Obesity, bioengineer.org reported.
The patient showed exertional dyspnea and subcutaneous emphysema without any vomiting, coughing, trauma, or signs of covert purging. His body mass index of 17 kg/m² falls within the mild severity range for anorexia nervosa under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Rapid Weight Loss May Drive Risk More Than Final BMI
The case contrasts with prior reports, which typically involved patients with BMIs between 10 and 14 kg/m². The authors suggest the rate of weight loss — approximately 11 kilograms per month — may be more pathophysiologically relevant than the absolute BMI value in triggering the condition.
Conservative Management Resolved Symptoms in Eight Days
Computed tomography of the chest confirmed isolated spontaneous pneumomediastinum, while a CT scan of the abdomen ruled out intra-abdominal pathology as the source of the air. The clinical team managed the patient with conservative measures and intensive nutritional rehabilitation; symptoms resolved completely after eight days, during which the patient gained 1.5 kilograms.
Male Presentation Adds to Clinical Rarity
Anorexia nervosa occurring in males is statistically uncommon, lending additional clinical interest to this presentation. The authors’ review of existing literature found a broad clinical spectrum in reported cases, ranging from benign, self-limited presentations to severe instances with multi-compartmental air leaks and cardiopulmonary compromise.
Answers About Pneumomediastinum in Malnutrition
What is spontaneous pneumomediastinum?
It is air that accumulates in the mediastinum — the space in the chest between the lungs — without trauma or medical procedures causing it. In this case, CT imaging confirmed the air was isolated to the chest cavity.
How fast did the patient recover?
Symptoms resolved completely after eight days of conservative management and intensive nutritional rehabilitation, during which the patient gained 1.5 kilograms.
Why is this case different from others?
Most prior cases involved patients with BMIs between 10 and 14 kg/m², while this patient presented at 17 kg/m², suggesting the speed of weight loss — 11 kilograms per month — may matter more than the final weight.
The findings suggest clinicians should recognize this complication can occur even in patients who have not reached the lowest BMI ranges seen in prior cases.