Extensive Subcutaneous Emphysema and Pneumomediastinum Following Intralesional Cryotherapy: A Case Report and Literature Review of a Rare and Unusual Complication
Author(s): Hatice Gencer Basol, Ismail Kursat Gurlek, Selma Aktas, Mustafa Boz, Betul Tiryaki Bastug
The Cryotherapy is a widely used treatment for various dermatological conditions, including warts, actinic keratosis, basal cell carcinoma, and keloid scars. While generally safe, potential complications of cryotherapy include blistering, hypopigmentation, hyperpigmentation, infection, scarring, subcutaneous emphysema, and pneumomediastinum. This report describes a rare case of extensive subcutaneous emphysema and pneumomediastinum following intralesional cryotherapy for a keloid. A 36-year-old female with a biopsy-proven keloid in the left scapular region, persisting for 30 years after surgery, underwent intralesional cryotherapy following eight unsuccessful sessions of intralesional steroid injections and superficial cryotherapy. One hour after the procedure, she presented with left shoulder, arm, and neck pain, swelling, dysphagia, and mild shortness of breath. Physical examination revealed subcutaneous crepitus, and thoracic CT confirmed subcutaneous emphysema and pneumomediastinum. The patient was hospitalized, monitored closely, and treated with intravenous ceftriaxone and levofloxacin to prevent mediastinitis. Oxygen therapy facilitated air resorption, and her oxygen saturation remained stable throughout. Follow-up imaging confirmed resolution of the pneumomediastinum and significant improvement in subcutaneous emphysema. This case underscores the importance of recognizing the rare but serious complications of intralesional cryotherapy. Early diagnosis, conservative management, and prophylactic antibiotics are essential to prevent severe outcomes, ensuring patient safety and optimal care.