bilateral spontaneous pneumothorax in a child with multisystem inflammatory syndrome associated with covid-19

Introduction: spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (covid-19), primarily reported in adults. pediatric cases with bilateral pneumothorax are much less reported. case presentation: we presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. his chest computed tomography (ct) showed a viral involvement pattern of pneumonia suggestive of covid-19. subsequently, he was confirmed with multisystem inflammatory syndrome in children (mis-c). while he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. a chest roentgenogram showed bilateral spontaneous pneumothorax. bilateral chest tubes were inserted, and his condition improved significantly after five days of admission to the intensive care unit. two weeks later, he was discharged in good condition. conclusions: children with mis-c associated with covid-19 may develop primary spontaneous pneumothorax. owing to the clinical picture overlapping with mis-c associated with covid-19, the timely diagnosis of pneumothorax may be challenging in such patients.