Pneumomediastinum as a presenting symptom of perforated sigmoid diverticulitis

We report a rare case of spontaneus pneumomediastinum (SPM) due to perforation of sigmoid diverticulitis in a patient suffering from Vogt-Koyanagi-Harda (VKH) syndrome and temporal arteritis, two rare diseases. This patient, who generally receives corticosteroid and methtrexate therapy, was admitted to hospital with vague abdominal and left flank pain, urinary disorders and low grade fever one day prior to admission. Initial evaluation including x-ray and laboratory tests was normal. Several hours later a repeat chest x-ray showed pneumomediastinum. Chest and abdominal CT were performed because of worsening abdominal pain, and revealed a perforated sigma.