Acute Pericarditis and Acute Pleuritis/Empyema Following Submandibular Infection in a COVID-19-Postive Patient: An Autopsy Revealing the Danger Space of the Neck
Archives of Pathology & Laboratory Medicine
Acute pericarditis and empyema are life-threatening complications of severe odontogenic infections; reports of these findings from an autopsy perspective are rare. We report an autopsy case demonstrating infection from the mandibular molars to the pericardium and pleura in a patient following COVID-19 infection. A 53-year-old woman with history of COVID-19 (and on repeat testing at admission) presented with submandibular abscess that grew Streptococcus anginosus. Despite incision and drainage of the neck abscess and medical treatment, her condition deteriorated, with sudden death a week after admission. An autopsy with histologic analysis was performed. Externally, a surgical incision containing purulent drainage was present in the right submandibular area. Internally, there were large, purulent pleural and pericardial effusions. The lungs had patchy green discoloration, and the epicardial and pericardial surfaces were covered with fibrinous exudates. Histologically, abscess and Gram-positive bacteria were identified in the soft tissue surrounding the thyroid. Gram-positive bacteria and fibrinous, necrotic exudate with acute inflammation were present on the pleural and pericardial surfaces, consistent with acute pleuritis/empyema, and acute pericarditis. This is the first reported autopsy case describing acute pleuritis with empyema and acute pericarditis complicating submandibular infection in a patient with history of COVID-19. The mechanism is consistent with descending infection by deep cervical fascia and spaces such as the “danger space” communicating with the mediastinum. COVID-19 infection may add an important factor compromising her health; this case highlights the importance of recognizing life-threatening complications of oral infections.
Anderson J, Fatemi S, Fullmer J, Zhang P. Acute pericarditis and acute pleuritis/empyema following submandibular infection in a COVID-19-postive patient: an autopsy revealing the danger space of the neck. Arch Pathol Lab Med. 2022 Sep;146(9):e131. doi: 10.5858/arpa.2022-0231-AB.
College of American Pathologists 2022 Annual Meeting (CAP22), October 8-11, 2022, New Orleans, LA.