Case of a Deep Neck Abscess During Treatment for COVID-19

Abstract

Patient: Male, 55-year-old Final Diagnosis: COVID 19 infection • deep neck infection • pyogenic arthritis Symptoms: Neck pain • shoulder pain Medication: Antibiotics Clinical Procedure: Incisional drainage Specialty: Otolaryngology Objective: Unusual clinical course Background: COVID-19 is treated using antiviral and immunosuppressive drugs. Therefore, patients treated for COVID-19 may have an increased risk of secondary infection and a masked inflammatory response. We present a case of a deep neck abscess caused by pyogenic sternoclavicular arthritis during treatment for COVID-19. Case Report: A 55-year-old man with COVID-19 was admitted to the hospital with hypoxemia. He was then treated with remdesivir, tocilizumab, and dexamethasone and was placed in the prone position. When his condition stabilized, pain in the left shoulder appeared. There was no fever or elevation in inflammation markers, and he was administered analgesics. However, the pain worsened and redness of the left neck appeared. Plain computed tomography (CT) showed swelling of the left neck muscles. Because cellulitis was suspected, he was treated with antibiotics, but his symptoms did not improve. Three days after the plain CT, contrast-enhanced CT showed sternoclavicular arthritis, deep neck abscess, and mediastinal abscess. Therefore, an emergency incisional drainage was performed under general anesthesia. Wound cleaning and drainage were continued after surgery, and after drainage tubes were removed, the patient was discharged on postoperative day 17. Conclusions: Cervical infections after COVID-19 treatment have been reported in a few cases. Particularly, deep neck abscesses require more attention since they could be fatal if not treated immediately. If a secondary infection is suspected in a patient treated with immunosuppressive drugs for COVID-19, a thorough physical examination should be performed to avoid misdiagnosis.

COVID-19 with neck cellulitis: an under recognized acute presentation

“…Sravani Mannuru [1]  , Márcio Luís Duarte [2]  and Leonardo Furtado Freitas A 51-year-old male with a recent COVID-19 diagnosis was presented to the emergency room with sudden neck swelling. Computed tomography (CT) of the neck revealed diffuse cellulitis with reactive sialadenitis and lymphadenopathy (Figure 1).…”

“…This unusual acute presentation arises from complications directly or indirectly associated with COVID-19, leading to systemic inflammatory response syndrome 1 . Some instances of deep neck abscesses linked to COVID-19 have been reported 2 , which can progress rapidly and pose life-threatening risks, underscoring the critical importance of early diagnosis 3 . Various factors, such as dental infections, trauma, tonsillitis, foreign bodies, and head and neck malignancies can precipitate deep neck infections and abscesses 3 .…”

“…Various factors, such as dental infections, trauma, tonsillitis, foreign bodies, and head and neck malignancies can precipitate deep neck infections and abscesses 3 . Immunocompromised patients with underlying systemic conditions, such as diabetes mellitus and chronic renal failure are at a higher risk of complications 2 . Although there are limited case reports linking COVID-19 with sudden neck swelling, deep neck abscesses can persist even after COVID-19 treatment completion 2 .…”

“…Immunocompromised patients with underlying systemic conditions, such as diabetes mellitus and chronic renal failure are at a higher risk of complications 2 . Although there are limited case reports linking COVID-19 with sudden neck swelling, deep neck abscesses can persist even after COVID-19 treatment completion 2 . Notably, SARS-CoV-2 infection can predispose individuals to secondary bacterial superinfections 4 .…”

“…. Neuroradiology Division, Radiology Department, University of Iowa Hospitals and Clinics, Iowa City, IA, USA[2]. Universidade de Ribeirão Preto -Campus Guarujá, Guarujá, SP, Brasil.…”