Abstract
BACKGROUNDCoronavirus disease 2019 (COVID-19) is an ongoing viral pandemic that has affected modern medical practice and can complicate known pathology. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes symptoms that may mimic a viral pneumonia, with potential for serious sequelae, including acute respiratory distress syndrome, coagulopathy, multiorgan dysfunction, systemic vascular abnormalities, and secondary infection.OBSERVATIONSThe authors describe a case of a 15-year-old boy who presented with a right subdural empyema and sinusitis while having active COVID-19 infection. The patient initially presented with left-sided weakness, frontal sinusitis, and subdural empyema. Emergent surgery was performed for evacuation of empyema and sinus debridement. Samples of purulent material within the subdural space were tested for SARS-CoV-2 by reverse transcriptase polymerase chain reaction. The patient had a successful recovery and regained the use of his right side after combined treatment. To our knowledge, this is the first reported case of a bacterial subdural empyema associated with frontal sinusitis in a coinfected patient with COVID-19 without evidence of COVID-19 intracranial infection.LESSONSA subdural empyema, which is a surgical emergency, was likely a superinfection caused by COVID-19. This, along with the coagulopathy caused by the virus, introduced unique challenges to the treatment of a known pathology.
Highlights
Coronavirus disease 2019 (COVID-19) is an ongoing viral pandemic that has affected modern medical practice and can complicate known pathology
SARS-CoV-2 genetic material and proteins have been documented in the central nervous system (CNS) of affected individuals.[6]
The virus is thought to invade the CNS via blood circulation and retrograde transport through the olfactory nerves, which may lead to hypoxic injury; increased vascular permeability; and autoimmune inflammatory changes, including changes of the capillary endothelium mediated directly via the angiotensin-converting enzyme 2 (ACE2) receptor.[6]
Summary
Coronavirus disease 2019 (COVID-19) is an ongoing viral pandemic that has affected modern medical practice and can complicate known pathology. The patient had a successful recovery and regained the use of his right side after combined treatment To our knowledge, this is the first reported case of a bacterial subdural empyema associated with frontal sinusitis in a coinfected patient with COVID-19 without evidence of COVID-19 intracranial infection. SARS-CoV-2 has significantly altered practice conditions of modern medicine, even in the setting of improved therapies and ongoing vaccination.[1] In addition to the severe pulmonary symptoms of COVID-19, numerous extrapulmonary manifestations include thrombosis, stroke, encephalopathy, anosmia, and ocular symptoms.[2]. These systemic effects are believed to arise from interaction of SARS-CoV-2 with the angiotensin-converting enzyme 2 (ACE2). Even with a positive diagnosis of COVID-19 on nasal swab SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR), intracranial purulent material remained negative for SARS-CoV-2
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