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Late-Term Complications of COVID-19: Retropharyngeal Infection and Myocarditis in a 26-Year-Old Patient
Mohammad Yousef1, Basel Abdelazeem1, Atefeh Kalantary1
1McLaren Health Care Corporation, Grand Blanc, Michigan, USA.
Insights
Deep neck space infections can be a late complication of coronavirus disease 2019 (COVID-19). This case highlights the importance of suspecting deep neck infections in adults with symptoms like fever and neck pain following COVID-19.
Area of Science:
- Infectious Diseases
- Cardiology
- Otolaryngology
Background:
- Deep neck space infections and viral myocarditis are known complications of coronavirus disease 2019 (COVID-19).
- Retropharyngeal infections presenting with COVID-19 are rare, with only three prior reported cases.
- This case represents the first description of retropharyngeal infection as a late complication in an adult post-COVID-19.
Purpose of the Study:
- To report a unique case of deep neck space infection and acute myocarditis as a late complication in an adult patient with a history of COVID-19.
- To discuss the clinical challenges in managing severe left ventricular dysfunction secondary to viral myocarditis in the context of a concurrent deep neck infection.
Main Methods:
- A 26-year-old female patient presented with symptoms of fever, neck swelling, and pain.
- Computed tomography (CT) scan of the neck confirmed tonsillitis with retropharyngeal infection.
- Echocardiography revealed severe left ventricular dysfunction (ejection fraction <20%) consistent with acute myocarditis.
Main Results:
- The patient was diagnosed with a retropharyngeal infection and acute viral myocarditis, presenting several weeks after initial COVID-19 infection.
- Treatment led to resolution of the deep neck infection and improvement in cardiac function (ejection fraction improved to 40%).
Conclusions:
- Deep neck space infections can manifest as a long-term complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
- Fever, neck swelling, and pain in adults should prompt consideration of deep neck space infection, even with a history of COVID-19.
- Acute viral myocarditis associated with SARS-CoV-2 can present weeks after the primary infection, posing diagnostic and therapeutic challenges.
Abstract:
Deep neck space infection and viral myocarditis related to coronavirus disease 2019 (COVID-19) have both been described in the medical literature. However, there are only three reported cases of retropharyngeal infection as a presenting pathology in the setting of COVID-19. A 26-year-old woman presented to the emergency room with fever and neck swelling and pain 1 month after COVID-19 infection. A computed tomography scan of the neck demonstrated tonsillitis with retropharyngeal infection. She was also found to have heart failure with an ejection fraction (EF) of <20% due to acute myocarditis. Her infection resolved and the EF improved to 40% prior to discharge. Our case is the first to describe retropharyngeal infection as a late complication in an adult with a history of COVID-19 several weeks previously. It also presented a clinical challenge in terms of tailoring goal-directed medical therapy to manage severe left ventricular dysfunction caused by myocarditis.
Learning Points:
Deep neck space infections may be a long-term complication of SARS-CoV-2 infection.Fever, neck swelling and pain should arouse suspicion of deep neck space infection even in adults.Acute viral myocarditis in the setting of SARS-CoV-2 can present many weeks after the initial infection.
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