Hamman Syndrome as a Rare Complication of Diabetic Ketoacidosis in a Patient with Chronic Heavy Alcohol Use: A Case Report

A 40-year-old man with altered mental status, abdominal pain, and vomiting was referred to our emergency department. Chest radiography revealed pneumomediastinum, raising concern for Boerhaave syndrome. Laboratory tests revealed high-anion-gap metabolic acidosis and hyperglycemic ketoacidosis, consistent with diabetic ketoacidosis (DKA). Endoscopic evaluation excluded esophageal perforation. Because the pneumomediastinum resolved with conservative management and DKA treatment, Hamman syndrome was diagnosed. The patient developed multiorgan dysfunction and required intensive care management, including mechanical ventilation and continuous renal replacement therapy. This case illustrates the diagnostic challenges of differentiating DKA from alcoholic ketoacidosis and Hamman syndrome from Boerhaave syndrome, highlighting the importance of a systematic approach and multidisciplinary critical care management for patients with severe metabolic derangements and multiorgan dysfunction.