Asunto(s)
COVID-19/complicaciones , Celulitis (Flemón)/diagnóstico , Mediastinitis/diagnóstico , Mucormicosis/diagnóstico , Insuficiencia Respiratoria/diagnóstico , Adulto , Anfotericina B/administración & dosificación , COVID-19/inmunología , COVID-19/virología , Celulitis (Flemón)/inmunología , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/terapia , Desbridamiento , Resultado Fatal , Humanos , Masculino , Mediastinitis/inmunología , Mediastinitis/microbiología , Mediastinitis/terapia , Mediastino/diagnóstico por imagen , Mucormicosis/inmunología , Mucormicosis/microbiología , Mucormicosis/terapia , Insuficiencia Respiratoria/inmunología , Insuficiencia Respiratoria/microbiología , Insuficiencia Respiratoria/terapia , SARS-CoV-2/inmunología , Pared Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
The incidence of mediastinitis after median sternotomy makes up 1-3%. This complication results prolonged hospital-stay, significant increase in treatment cost and high mortality (up to 75%). Severe COVID-19 pneumonia is often manifested by coughing, that impairs sternum stability after osteosynthesis. Moreover, concomitant leukopenia increases the risk of mediastinitis. Viral pneumonia and mediastinitis are complicated by respiratory failure and mutually potentiate the negative effect. Negative pressure wound therapy (NPWT) with combined antibiotic therapy ensures a favorable outcome even in patients with postoperative mediastinitis and osteomyelitis combined with viral pneumonia.
Asunto(s)
Antibacterianos/uso terapéutico , COVID-19/complicaciones , Mediastinitis/terapia , Terapia de Presión Negativa para Heridas/métodos , Osteomielitis/terapia , Esternotomía/efectos adversos , Esternón/cirugía , Infección de la Herida Quirúrgica/terapia , COVID-19/diagnóstico , Humanos , Mediastinitis/diagnóstico , Osteomielitis/diagnóstico , Osteomielitis/etiología , Complicaciones Posoperatorias , SARS-CoV-2 , Infección de la Herida Quirúrgica/diagnóstico , Resultado del TratamientoRESUMEN
A 50-year-old Caucasian man presented to the emergency department during the early stages of the COVID-19 pandemic with a rapidly progressive facial swelling, fever, malaise and myalgia. The patient had recently travelled to a COVID-19-prevalent European country and was therefore treated as COVID-19 suspect. The day before, the patient sustained a burn to his left forearm after falling unconscious next to a radiator. A CT neck and thorax showed a parapharyngeal abscess, which was surgically drained, and the patient was discharged following an intensive care admission. He then developed mediastinitis 3 weeks post-discharge which required readmission and transfer to a cardiothoracic unit for surgical drainage. This report discusses the evolution of a deep neck space infection into a mediastinitis, a rare and life-threatening complication, despite early surgical drainage. This report also highlights the difficulties faced with managing patients during the COVID-19 pandemic.