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. 2021 Oct 26;8(10):002759.
doi: 10.12890/2021_002759. eCollection 2021.

Late-Term Complications of COVID-19: Retropharyngeal Infection and Myocarditis in a 26-Year-Old Patient

Mohammad Yousef  1 , Basel Abdelazeem  1 , Atefeh Kalantary  1 , Rebecca Pratiti  1
Affiliations

Late-Term Complications of COVID-19: Retropharyngeal Infection and Myocarditis in a 26-Year-Old Patient

Mohammad Yousef et al. Eur J Case Rep Intern Med. .

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.

Keywords: COVID-19; SARS-CoV-2; deep neck space infection; retropharyngeal abscess; viral myocarditis.

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Conflict of interest statement

Conflicts of Interests: The authors declare there are no competing interests.

Figures

Figure 1
Figure 1
Chest x-ray: normal cardiopulmonary anatomy.
Figure 2
Figure 2
ECG sinus tachycardia at 160 beats per minute.
Figure 3
Figure 3
CT scan of the soft tissue of the neck with contrast: non-loculated fluid collection within the retropharyngeal region (arrow in panel-A) extending to the cervicothoracic junction (asterisk in panel-B).
Figure 4
Figure 4
First transthoracic echocardiogram: ejection fraction <20%.
Figure 5
Figure 5
Second transthoracic echocardiogram: ejection fraction 40%.
See this image and copyright information in PMC

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