{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:59:04Z","timestamp":1777042744087,"version":"3.51.4"},"reference-count":34,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Measles remains a major global public health challenge as declining vaccination coverage fuels outbreaks worldwide. Although pneumonia is the most recognized respiratory complication, spontaneous air leak syndrome\u2014including pneumomediastinum, subcutaneous emphysema, and pneumoperitoneum\u2014is rarely documented. We report the case of a 9-year-old previously healthy girl with no documented measles\u2013rubella vaccination who presented with fever, maculopapular exanthem, Koplik spots, and persistent cough. Measles was confirmed by both immunoglobulin M enzyme-linked immunosorbent assay and real-time reverse transcription polymerase chain reaction. She developed sudden cervicothoracic swelling and chest pain. Chest radiography revealed pneumomediastinum and subcutaneous emphysema; computed tomography confirmed extensive air leak including pneumoperitoneum. Flexible bronchoscopy and upper gastrointestinal endoscopy excluded structural airway and esophageal injury. Laboratory evaluation revealed elevated hepatic transaminases, gamma-glutamyl transferase, lactate dehydrogenase, and D-dimer. Conservative management with high-flow supplemental oxygen and clinical surveillance led to progressive resolution. The patient was discharged on hospital day three, asymptomatic and breathing room air. This case highlights the spectrum of air leak complications in measles and supports conservative management in hemodynamically stable pediatric patients when structural injury has been excluded.<\/jats:p>","DOI":"10.3390\/idr18030039","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T12:29:11Z","timestamp":1777033751000},"page":"39","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spontaneous Pneumomediastinum, Subcutaneous Emphysema, and Pneumoperitoneum in RT-PCR-Confirmed Measles: A Pediatric Case Report"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3424-1382","authenticated-orcid":false,"given":"Roberto Miguel","family":"Dami\u00e1n-Negrete","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d, Guadalajara 44280, Mexico"},{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Z\u00fa\u00f1iga 45641, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1026-9558","authenticated-orcid":false,"given":"Alondra Denisse","family":"Hern\u00e1ndez-Luna","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d, Guadalajara 44280, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0126-5452","authenticated-orcid":false,"given":"Roc\u00edo Guadalupe","family":"Cano-Arias","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d, Guadalajara 44280, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0980-5427","authenticated-orcid":false,"given":"Antonio","family":"Dur\u00e1n-Plaza","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d, Guadalajara 44280, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0251-6425","authenticated-orcid":false,"given":"Judith Carolina","family":"De Arcos-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Z\u00fa\u00f1iga 45641, Mexico"},{"name":"Department of Pediatrics, Hospital Civil de Oriente, Tonal\u00e1 45425, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9571-890X","authenticated-orcid":false,"given":"Kathya Anal\u00ed","family":"Rodr\u00edguez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d, Guadalajara 44280, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2256-6646","authenticated-orcid":false,"given":"Braulio Dazahel","family":"Gonz\u00e1lez-Flores","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d, Guadalajara 44280, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7409-3690","authenticated-orcid":false,"given":"Pedro Iv\u00e1n","family":"Navarro-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Civil de Oriente, Tonal\u00e1 45425, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1901-392X","authenticated-orcid":false,"given":"Jaime","family":"Briseno-Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco de Z\u00fa\u00f1iga 45641, Mexico"},{"name":"Department of Pediatrics, Hospital Civil de Oriente, Tonal\u00e1 45425, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2490","DOI":"10.1016\/S0140-6736(17)31463-0","article-title":"Measles","volume":"390","author":"Moss","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Laksono, B.M., de Vries, R.D., McQuaid, S., Duprex, W.P., and de Swart, R.L. (2016). Measles Virus Host Invasion and Pathogenesis. Viruses, 8.","DOI":"10.3390\/v8080210"},{"key":"ref_3","unstructured":"World Health Organization (2026, March 01). Measles. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/measles."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S0140-6736(10)62352-5","article-title":"Measles","volume":"379","author":"Moss","year":"2012","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.15585\/mmwr.mm7345a4","article-title":"Progress Toward Measles Elimination\u2014Worldwide, 2000\u20132023","volume":"73","author":"Minta","year":"2024","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_6","unstructured":"Pan American Health Organization, and World Health Organization (2025). Epidemiological Alert: Measles in the Americas Region, 28 February 2025, PAHO\/WHO. Available online: https:\/\/www.paho.org\/sites\/default\/files\/2025-03\/2025-feb-28-phe-epialert-measles-eng-final.pdf."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1086\/377712","article-title":"The Clinical Significance of Measles: A Review","volume":"189","author":"Perry","year":"2004","journal-title":"J. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e109","DOI":"10.1097\/INF.0000000000005054","article-title":"A Rare and Forgotten Complication of Measles: A Case Report of Subcutaneous Emphysema and Pneumomediastinum and Literature Review","volume":"45","author":"Kaba","year":"2025","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/BF00442587","article-title":"Mediastinal and Subcutaneous Emphysema Associated with Childhood Measles","volume":"142","author":"Odita","year":"1984","journal-title":"Eur. J. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/INF.0b013e3182a6e1cd","article-title":"High Incidence of Subcutaneous Emphysema in Children in a Somali Refugee Camp during Measles Outbreak","volume":"33","author":"Moons","year":"2014","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/1099-0496(200101)31:1<67::AID-PPUL1009>3.0.CO;2-J","article-title":"Spontaneous Pneumomediastinum in Children","volume":"31","author":"Chalumeau","year":"2001","journal-title":"Pediatr. Pulmonol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/00005792-194412000-00001","article-title":"Malignant Interstitial Emphysema of the Lungs and Mediastinum as an Important Occult Complication in Many Respiratory Diseases and Other Conditions: An Interpretation of the Clinical Literature in the Light of Laboratory Experiment","volume":"23","author":"Macklin","year":"1944","journal-title":"Medicine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"850","DOI":"10.4329\/wjr.v6.i11.850","article-title":"Spontaneous Pneumomediastinum and Macklin Effect: Overview and Appearance on Computed Tomography","volume":"6","author":"Murayama","year":"2014","journal-title":"World J. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1378\/chest.120.2.543","article-title":"The Macklin Effect: A Frequent Etiology for Pneumomediastinum in Severe Blunt Chest Trauma","volume":"120","author":"Wintermark","year":"2001","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/000992286800700106","article-title":"Pneumomediastinum and Subcutaneous Emphysema in Measles","volume":"7","author":"Bloch","year":"1968","journal-title":"Clin. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s10096-009-0838-x","article-title":"Measles-Induced Respiratory Distress, Air-Leak and ARDS","volume":"29","author":"Piastra","year":"2010","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1007\/BF00974057","article-title":"Non-Iatrogenic Pneumomediastinum in Infancy and Childhood","volume":"1","author":"McSweeney","year":"1973","journal-title":"Pediatr. Radiol."},{"key":"ref_18","first-page":"25","article-title":"Spontaneous Pneumomediastinum Associated with Subcutaneous Emphysema, Pneumopericardium and Pneumothorax: A Rare Association Complicating Measles","volume":"115","author":"Mastroianni","year":"2024","journal-title":"Recenti Prog. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"403","DOI":"10.7861\/clinmedicine.18-5-403","article-title":"Pneumomediastinum Complicating Adult-Onset Measles","volume":"18","author":"Janmohamed","year":"2018","journal-title":"Clin. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1186\/1752-1947-7-223","article-title":"The CARE Guidelines: Consensus-Based Clinical Case Reporting Guideline Development","volume":"7","author":"Gagnier","year":"2013","journal-title":"J. Med. Case Rep."},{"key":"ref_21","unstructured":"Instituto de Diagn\u00f3stico y Referencia Epidemiol\u00f3gicos (InDRE), Direcci\u00f3n General de Epidemiolog\u00eda, and Secretar\u00eda de Salud (Mexico) (2026, March 04). Lineamientos para la Vigilancia Epidemiol\u00f3gica de la Enfermedad Febril Exantem\u00e1tica por Laboratorio (LVL_EFE_4T), Available online: https:\/\/www.gob.mx\/cms\/uploads\/attachment\/file\/487585\/LVL_EFE_4T.pdf."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1001\/archinte.1984.00350190143024","article-title":"Subcutaneous and Mediastinal Emphysema: Pathophysiology, Diagnosis, and Management","volume":"144","author":"Maunder","year":"1984","journal-title":"Arch. Intern. Med."},{"key":"ref_23","unstructured":"Iteen, A.J., Bianchi, W., and Sharman, T. (2026, March 04). Pneumomediastinum, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557440\/."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2638","DOI":"10.1097\/00003246-200007000-00078","article-title":"Pneumoperitoneum: A Review of Nonsurgical Causes","volume":"28","author":"Mularski","year":"2000","journal-title":"Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1126\/science.aay6485","article-title":"Measles Virus Infection Diminishes Preexisting Antibodies That Offer Protection from Other Pathogens","volume":"366","author":"Mina","year":"2019","journal-title":"Science"},{"key":"ref_26","first-page":"521","article-title":"Subcutaneous and Mediastinal Emphysema Following Respiratory Tract Complications in Measles","volume":"58","author":"Yalaburgi","year":"1980","journal-title":"S. Afr. Med. J."},{"key":"ref_27","first-page":"346","article-title":"Subcutaneous Emphysema as a Complication of Measles","volume":"49","author":"Amin","year":"1972","journal-title":"East Afr. Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1007\/BF01710744","article-title":"Measles Associated Hepatobiliary Disease: An Overview","volume":"21","author":"Khatib","year":"1993","journal-title":"Infection"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"B\u00eerlu\u0163iu, V., and B\u00eerlu\u0163iu, R.-M. (2024). Measles\u2014Clinical and Biological Manifestations in Adult Patients, Including a Focus on the Hepatic Involvement: Results from a Single-Center Observational Cohort Study from Romania. J. Clin. Med., 13.","DOI":"10.3390\/jcm13185535"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1053\/jinf.2002.1048","article-title":"Circulating D-Dimer and Thrombomodulin Levels in Acute Febrile Phase of Measles","volume":"45","author":"Ohnishi","year":"2002","journal-title":"J. Infect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1016\/j.rmed.2008.03.023","article-title":"Management of Spontaneous Pneumomediastinum Based on Clinical Experience of 25 Cases","volume":"102","author":"Takada","year":"2008","journal-title":"Respir. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0025-6196(11)60560-0","article-title":"Spontaneous Pneumomediastinum: Analysis of 62 Consecutive Adult Patients","volume":"84","author":"Iyer","year":"2009","journal-title":"Mayo Clin. Proc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.jpedsurg.2015.03.024","article-title":"Management of Spontaneous Pneumomediastinum in Children","volume":"50","author":"Fitzwater","year":"2015","journal-title":"J. Pediatr. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"5239","DOI":"10.21037\/jtd.2017.10.149","article-title":"Does Oxygen Therapy Increase the Resolution Rate of Primary Spontaneous Pneumothorax?","volume":"9","author":"Park","year":"2017","journal-title":"J. Thorac. Dis."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/3\/39\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T13:12:05Z","timestamp":1777036325000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/18\/3\/39"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["idr18030039"],"URL":"https:\/\/doi.org\/10.3390\/idr18030039","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]}}}