A 70-year-old man with diabetes was treated with a sodium glucose cotransporter 2 (SGLT2) inhibitor. He developed vomiting and epigastric pain and was diagnosed with diabetic ketoacidosis (DKA). Computed tomography (CT) revealed mediastinal emphysema. As Boerhaave syndrome could not be ruled out, treatment was initiated in parallel with DKA treatment. After the DKA healed, the mediastinal emphysema disappeared. DKA combined with mediastinal emphysema is known as Hamman syndrome. There have been no reports of Hamman syndrome in elderly patients with diabetes caused by SGLT2 inhibitors. His symptoms mimicked the course of Boerhaave syndrome, and such cases have a high risk of misdiagnosis.
Keywords: Boerhaave syndrome; Diabetic ketoacidosis; Hamman syndrome; Mediastinal emphysema; Sodium glucose cotransporter 2 inhibitors.