Severe parapharyngeal abscess that developed significant complications: management during the COVID-19 pandemic

BMJ Case Rep. 2020 Dec 22;13(12):e236449. doi: 10.1136/bcr-2020-236449.

Abstract

A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.

Keywords: anaesthesia; cardiothoracic surgery; ear; nose and throat/otolaryngology; oral and maxillofacial surgery.

Publication types

  • Case Reports

MeSH terms

  • COVID-19 Drug Treatment*
  • COVID-19* / epidemiology
  • COVID-19* / therapy
  • Catastrophic Illness / therapy
  • Diagnosis, Differential
  • Drainage* / adverse effects
  • Drainage* / methods
  • Humans
  • Infection Control / methods
  • Male
  • Mediastinitis* / diagnosis
  • Mediastinitis* / etiology
  • Mediastinitis* / physiopathology
  • Mediastinitis* / surgery
  • Middle Aged
  • Neck / diagnostic imaging
  • Neck / surgery
  • Patient Care Management / methods*
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / physiopathology
  • Postoperative Complications* / surgery
  • Retropharyngeal Abscess* / diagnosis
  • Retropharyngeal Abscess* / physiopathology
  • Retropharyngeal Abscess* / surgery
  • SARS-CoV-2
  • Thoracic Surgical Procedures / methods*
  • Treatment Outcome