Pneumomediastinum and pericarditis are distinct etiologies of chest pain with unique mechanisms and specific treatments, but they can exhibit overlapping characteristics.
A 19-year-old male with well-controlled asthma and anti-hydroxy-3-methylglutaryl-co-enzyme A reductase (anti-HMGCR) inflammatory myopathy (IM) under corticosteroids, immunoglobulins and methotrexate, presented with three-day retrosternal pleuritic pain, triggered by a Valsalva maneuver during exercise at the gym.

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