Subdural empyema in patient with SARS-CoV-2 positivity: A rare case report of 3 patients

Abstract

Coronavirus disease 2019 (COVID-19) is a viral pandemic and a matter of concern. It also mimics viral pneumonia with cough and fever but also causes severe sequels and various complications. Subdural empyema is a very rare brain infection presenting mostly with fever, weakness, and altered level of consciousness, and has been recently noted as a new complication of COVID-19. This report presents 3 cases of subdural empyema with a prior history of COVID-19. The first case is a 17-year-old female presented with a 1-week history of severe progressive headache, right-sided ptosis, and left-sided hemiplegia with a history of COVID-19 in about 40 days before admission. The second one is a 41-year-old female presented with a 2-week history of fatigue, severe progressive headache which deteriorated while sitting, left tarsal swelling, and left-sided hemiparesis accompanied by drowsiness since 1 day before admission and a history of COVID-19 in about 50 days before admission. The third one is a 47-year-old gentleman with a known case of epilepsy, who presented with a 2-day history of headache and fever and an event of Generalized Tonic Colonic (GTC) seizure on the day of admission. The patient had a history of multiple head traumas during past years, which led to craniectomy, and also a history of COVID-19 about 46 days before admission. Emergent surgery was performed to evacuate empyema, and patients underwent subsequent anti-bacterial treatment. All patients showed clinical improvement. This report highlights a potential link between SARS-COV-2 infection and the patient's development of subdural empyema.