Subcutaneous emphysema is a complication that resulted in severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) pneumonia that needs prompts and finds the causes of it. Case presentation: Herein, we describe a 47 years old male with COVID 19 who was admitted to the ICU and developed subcutaneous emphysema. His oxygen saturation (SaO2) was 86% and required supplemental oxygen, where he was improved to 95%. The chest X-ray shows bilateral lung infiltrates and diffuses subcutaneous emphysema in the subcutaneous tissues of the chest, and he was recommended for intubation and thoracostomy tube for treatment. The subcutaneous emphysema was canulated and developed right plural effusion and drained almost 30 cm3 of blood complicated with pneumothorax. The pneumothorax resolved, but still, there is plural effusion, the big tail was removed, and a new chest tube was inserted posterior and anterior plural effusion, despite two chest tubes the patient did not resolve, chest X-ray was done and showed bilateral plural effusion and pneumothorax.

Keywords : COVID-19, SARS-CoV-2, Complication, Subcutaneous Emphysema,