Ventricular empyema associated with severe pyogenic meningitis in COVID-19 adult patient: Case report

Abstract

Background: Coronavirus Disease 2019 (COVID-19) pandemic raised global attention especially due to the severe acute respiratory symptoms associated to it. However, almost one third of patients also develop neurological symptoms. The aim of the present study is to describe the case of a previously health adult that evolved cerebral ventricular empyema in the IV ventricle during COVID-19 infection treatment. Case Description: A 49-year-old man with COVID-19 developed pneumonia caused by multidrug-resistant Acinetobacter baumannii. After treating adequate treatment, sedation was switched off without showing appropriate awakening. Brain CT was performed with evidence of communicating hydrocephalus. External ventricular shunt (EVD) was implant with intraoperative cerebrospinal fluid suggestive of meningitis with a positive culture for oxacillin-sensitive Staphylococcus hominis. Twenty days after EVD, meningitis treatment was finished and with 2 negative cultures, conversion to ventriculoperitoneal shunt was performed. In the following week, during the evaluation of the patient in intensive care, quadriplegia and absence of spontaneous respiratory movement were evidenced, just maintaining head movement. Brain MRI was performed with a diagnosis of ventriculitis associated with pus collections on the IV ventricle. The patient underwent microsurgical drainage removal of the shunt, with a positive intraventricular collection culture for Klebsiella pneumoniae carbapenemase and multidrug-resistant Pseudomonas aeruginosa, without improvement in the neurological condition. After 14 weeks of hospitalization, the patient died. Conclusion: It is well known that COVID-19 has potential to directly attack and cause severe damage to the central nervous system; however, ventricular empyema is an extremely rare life-threatening complication.

Intracranial Empyemas in the COVID-19 Era: A New Phenomenon? A Paediatric Case Series and Review of the Literature

“…A literature review identified 608 relevant articles using the above search terms. Of these, 5 papers described purulent intracranial infections directly associated with COVID-19 infections: 2 adult case reports and 3 paediatric [13][14][15][16][17]. Clinical data for these reports are summarised in Table 3.…”

“…One patient initially developed hydrocephalus secondary to meningitis while in ICU being treated for COVID-19 pneumonia; only on internalisation of a ventriculoperitoneal shunt and subsequent deterioration was the empyema diagnosed [14]. Across 3 patients, the COVID-19 diagnosis preceded identification of empyema diagnosis by 20-54 days [13,14,17]; in 2 patients, the diagnoses of empyema and COVID-19 were concurrent [15,16]. Empyemas reported in the literature were convexity (n = 3), parafalcine (n = 1), and intraventricular (n = 1) [13][14][15][16][17] (Table 3).…”

The Collateral Effects of COVID-19 Pandemic on the Status of Carbapenemase-Producing Pathogens

“…We present below a summary of studies on carbapenemase-producing Enterobacteriaceae and A. baumannii in COVID-19 patients. Regarding P. aeruginosa , and while this multiresistant pathogen is known to produce carbapenemases (VIM-2, GES-7, VEB-1, IMP-1, KPC-2, PER-1) ( Cantón et al., 2020 ), and despite being among top pathogens co-infecting COVID-19 patients ( Ramadan et al., 2020 ; Senok et al., 2021 ; Westblade et al., 2021 ), sometimes associated with severe pyogenic infection ( Meguins et al., 2021 ), literature has not yet extensively reported carbapenemases from this organism in COVID-19 patients. This calls for vigilant investigations to fill such gap of knowledge regarding this significant nosocomial pathogen.…”

Endoscopic lavage of the cerebral ventricular system for ventriculitis treatment in a patient with complicated new coronavirus infection (COVID‑19)

“…Однако абсцесс или эмпиема головного мозга у пациентов с COVID-19 -редкие осложнения. Описано лишь несколько подобных случаев [3,4,9].…”

“…В 8 % случаев COVID-19 может сопровождаться развитием бактериальной или грибковой инфекции [2]. В интернетресурсе PubMed (https://pubmed.ncbi.nlm.nih.gov / ) найдено всего несколько описаний развития бактериального менингита у взрослых пациентов с COVID-19 [3][4][5]. Каких-либо обобщающих исследований в этой области не найдено.…”