This article aims to highlight an event of a COVID-19 pneumonia presenting as a Spontaneous Pneumomediastinum (SPM) and discuss the possible mechanism and prognosis of this association A 67 year old gentleman, known hypertensive and a recently diagnosed Diabetic, presented to the Emergency Department of a tertiary care hospital, with complaints of acute onset chest tightness and breathlessness of 1 day duration, which had worsened over the last few hours At presentation he had tachycardia (HR 110 beats/min), tachypnoea (RR - 26/min), blood pressure was 140/90 mmHg, and temperature was normal, with an oxygen saturation of 90% on room air He was immediately started on oxygen with Non Rebreather mask, following which saturation improved to 94% Random blood glucose was 285mg/dl and a complete blood count showed significant leukocytosis (Total leukocyte count 21,900 cells per uL), with neutrophilia (93%) and lymphopenia (3%) There was evidence of acute kidney injury (urea - 74 8 mg/dl, Creatinine - 2 4 mg/dl) and inflammatory markers were markedly elevated, with C Reactive Protein -263 4 mg/L and ferritin - 1559 ng/mL D-dimer and NT-pro BNP were done, which were elevated as well (5043 ng/mL and 10400 pg/mL respectively) High Resolution Computerised Tomography (HRCT) thorax was done which showed diffuse ground glass opacities with interlobular septal thickening Note of pneumomediastinum and pneumopericardium was also made Due to the ongoing pandemic and the patients symptom profile, a COVID-19 RT-PCR was sent which was positive Patient deteriorated rapidly in the emergency following which he was intubated and put into mechanical ventilation He succumbed within 6 hours of arrival to the hospital