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.