Odontogen frontoparial epidural and subdural empyema complicated with frontal intracerebral abscess and Covid

Abstract

Introduction: Cerebral infections (frontoparietal extradural and subdural empyema) following a dental abscess and multiple sinusitis is a rare and potentially devastating entity even in the era of modern diagnosis and treatment.
 Case presentation: We present a patient with parietal epidural and subdural empyema and intracerebral frontal abscess, sinusitis and dental abscess, chronic consumer of alcohol and with neglected diabetes mellitus. He was initially diagnosed with encapsulated hematoma and sinusitis. The pus obtained at the intervention was certified by our laboratory as sterile with the consequent difficulty in antibiotic treatment and who induced a longer antibiotic treatment, a second surgical intervention for an encapsulated frontal abscess, a longer hospitalisation and favoured contamination with Covid 19. Despite these, the patient had a finally good evolution.
 Conclusions: A frontoparietal extradural and subdural empyema and an intracerebral frontal abscess produced by a dental abscess and sinusitis is a rare and potentially lethal complication. The multidisciplinary approach between radiologist, neurosurgeon, otolaryngologist, dentist, microbiologists is mandatory for a proper diagnosis and treatment of these pathologies.

Intracranial complications of hypercoagulability and superinfection in the setting of COVID-19: illustrative cases

“… 14 Subdural empyema is a well-described sinusitis-associated intracranial infection that may be associated with venous sinus thrombosis or septic thrombophlebitis and can spread from the sinonasal region through retrograde septic thrombophlebitis of valveless emissary veins. 15 In the cases presented, hypercoagulability-induced thromboses and superinfection-induced thrombophlebitis may have played a compounding role in development of a severe empyema.…”

Sinonasal complications of severe acute respiratory syndrome coronavirus‐2: A single center case series

“…[23][24][25] There have been isolated reports of these sinonasal complications in the setting of SARS-CoV-2 described in the medical literature. 8,10,11,13 The nasal cavity and nasopharynx are known reservoirs of SARS-CoV-2 viral load and replication. With this high viral activity, the virus is hypothesized to cascade a cytokine driven inflammatory response, which exacerbates endothelial damage and potentiates these severe sinonasal complications.…”

“… 23 , 24 , 25 There have been isolated reports of these sinonasal complications in the setting of SARS‐CoV‐2 described in the medical literature. 8 , 10 , 11 , 13 …”

“… 1 , 3 , 4 In the otolaryngologic literature, there are isolated reports of atypical, severe presentations in context of SARS‐CoV‐2 infection, however, there are no larger comprehensive series. 7 , 8 , 9 , 10 , 11 , 12 , 13 We present our single center series of nine cases of patients with severe complications from sinonasal disease in the setting of acute SARS‐CoV‐2 infection. Institutional Review Board approval at the University of North Carolina was obtained prior to completing the study.…”

“…Through this very mechanism, severe systemic inflammatory sequela beyond the expected pulmonary system has been described, with life‐threatening multi‐organ dysfunction 1,3,4 . In the otolaryngologic literature, there are isolated reports of atypical, severe presentations in context of SARS‐CoV‐2 infection, however, there are no larger comprehensive series 7–13 . We present our single center series of nine cases of patients with severe complications from sinonasal disease in the setting of acute SARS‐CoV‐2 infection.…”