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Case Reports
. 2023 Apr 16;59(4):771.
doi: 10.3390/medicina59040771.

Epidural Abscesses as a Complication of Interleukin-6 Inhibitor and Dexamethasone Treatment in a Patient with COVID-19 Pneumonia: A Case Report

Valdis Ģībietis  1   2
Affiliations
Case Reports

Epidural Abscesses as a Complication of Interleukin-6 Inhibitor and Dexamethasone Treatment in a Patient with COVID-19 Pneumonia: A Case Report

Valdis Ģībietis. Medicina (Kaunas). .

Abstract

A 66-year-old female patient was hospitalized with severe COVID-19 pneumonia, which led to hypoxia requiring oxygen support with high-flow nasal cannulae. She received anti-inflammatory treatment with a 10-day dexamethasone 6 mg PO course and a single infusion of IL-6 monoclonal antibody tocilizumab 640 mg IV. Treatment led to gradual reduction of oxygen support. However, on Day 10, she was found to have Staphylococcus aureus bacteremia with epidural, psoas, and paravertebral abscesses as the source. Targeted history taking revealed a dental procedure for periodontitis 4 weeks prior to hospitalization as the probable source. She received an 11-week antibiotic treatment, which led to resolution of the abscesses. This case report highlights the importance of individual infection risk assessment before the initiation of immunosuppressive treatment for COVID-19 pneumonia.

Keywords: COVID-19; bacteremia; dexamethasone; epidural abscess; tocilizumab.

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Conflict of interest statement

The author declares no conflict of interest.

Figures

Figure 1
Figure 1
Axial computed tomography image of the lungs on the first day in the hospital.
Figure 2
Figure 2
Sagittal magnetic resonance image showing dorsal epidural infiltration with small abscesses from the upper border of Th9 to Th12 (arrows).
See this image and copyright information in PMC

References

    1. Abani O., Abbas A., Abbas F., Abbas M., Abbasi S., Abbass H., Abbott A., Abdallah N., Abdelaziz A., Abdelfattah M., et al. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): A randomised, controlled, open-label, platform trial. Lancet. 2021;397:1637–1645. doi: 10.1016/s0140-6736(21)00676-0. - DOI - PMC - PubMed
    1. Gordon A.C., Mouncey P.R., Al-Beidh F., Rowan K.M., Nichol A.D., Arabi Y.M., Annane D., Beane A., Van Bentum-Puijk W., Berry L.R., et al. Interleukin-6 Receptor Antagonists in Critically Ill Patients with COVID-19. N. Engl. J. Med. 2021;384:1491–1502. doi: 10.1056/nejmoa2100433. - DOI - PMC - PubMed
    1. National Institutes of Health. COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. [(accessed on 5 April 2023)]; Available online: https://www.covid19treatmentguidelines.nih.gov/ - PubMed
    1. Infection risk with the use of interleukin inhibitors in hospitalized patients with COVID-19: A narrative review. Infez. Med. 2021;29:495–503. doi: 10.53854/liim-2904-1. - DOI - PMC - PubMed
    1. Chang F.-Y., Peacock J.E., Musher D.M., Triplett P., MacDonald B.B., Mylotte J.M., O’Donnell A., Wagener M.M., Yu V.L. Staphylococcus aureus Bacteremia. Medicine. 2003;82:333–339. doi: 10.1097/01.md.0000091184.93122.09. - DOI - PubMed

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