A 32-year-old man who was a nonsmoker presented with a 2-day history of fever (temperature, up to 40°C), chills, rigors, and myalgia. The findings of his chest radiograph taken on hospital admission were unremarkable, but the HRCT scan of his thorax demonstrated consolidation in the medial basal segment of the left lower lobe, which is consistent with SARS. Therapy with ribavirin and methylprednisolone was administered, with a good initial clinical response. However, his fever recurred on day 5, followed by both clinical and radiologic deterioration. Seventeen days after hospital admission, his condition acutely deteriorated further with worsening dyspnea. Chest radiography showed bilateral lower zone ground-glass infiltrates with patchy consolidations. His HRCT scan demonstrated extensive ground-glass opacities and consolidation, plus an extensive pneumomediastinum with air tracking up to the roots of the neck, creating subcutaneous emphysema. This was managed conservatively, but on the 21st day after hospital admission, he experienced oxygen desaturation to an arterial oxygen saturation of 70%, despite receiving maximal oxygen therapy via a rebreathing mask. He was transferred to the ICU, where a chest radiograph confirmed small (ie, < 10%) bilateral apical pneumothoraces. He was able to maintain borderline oxygenation while receiving maximal oxygen therapy. Chest drain insertion and mechanical ventilation were refused by the patient. Serial chest radiographs showed a gradual reduction in the size of the pneumothoraces. An HRCT scan performed on day 31 after hospital admission showed only a small residual pneumothorax on the right side and a slowly resolving pneumomediastinum. On day 41, an HRCT scan demonstrated complete resolution of the pneumothoraces on both sides.