Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 6 2023 03 12 280 283 EN Hamid Talebzadeh Department of General Surgery, Al Zahra Hospital, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran. Sadegh Mazaheri-Tehrani Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. mohammad fakhrolmobasheri Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. 2022 04 20 2022 06 21 Spontaneous pneumomediastinum (SPM) is a rare clinical entity. In the normal population, it is more likely to occur in people with conditions including chronic obstructive pulmonary diseases and asthma. In the context of COVID-19 few cases of SPM have been reported which most of them were patients with severe lung parenchymal inflammation or patients under mechanical ventilation. In this case, we report a young male with a history of minor childhood asthma who presented with acute dyspnea, forceful coughs, and subcutaneous emphysema. Chest computed tomography had no clues for COVID-19, however, pneumomediastinum and subcutaneous emphysema were obvious. He was primarily diagnosed with acute asthma exacerbation causing SPM but eventually, he tested positive for SARS-COV-2, therefore, he underwent the standard treatment for COVID-19 and the SPM was managed conservatively. Finally, after 12 days of hospitalization, he was discharged in favorable clinical condition. https://crcp.tums.ac.ir/index.php/crcp/article/view/681