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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2479-5462
Case Report

Otogenic Brain Abscess and Concomitant Acute COVID-19 Infection: Case Report and Review of the Literature

Artem Rafaelian 
1   Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
,
Sae-Yeon Won
1   Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
2   Department of Neurosurgery, University Hospital of Rostock, Rostock, Mecklenburg-Vorpommern, Germany
,
Svorad Trnovec
1   Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
3   Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
,
Bedjan Behmanesh
1   Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
3   Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
,
Susanne Barz
4   Department of Anesthesiology, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
,
Christoph Busjahn
4   Department of Anesthesiology, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
,
Daniel A. Reuter 
4   Department of Anesthesiology, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
,
Lichun Zhang
5   Department of Otorhinolaryngology, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
,
Robert Mlynski
5   Department of Otorhinolaryngology, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
,
Thomas Freiman
1   Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
,
Florian Gessler
1   Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
6   Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
,
Daniel Dubinski
1   Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
7   Department of Neurosurgery, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
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Funding None.
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Abstract

Background 2019 coronavirus disease (COVID-19) has attracted global attention primarily because of the severe acute respiratory symptoms associated with it. However, nearly one third of the patients also present with neurological symptoms. This report describes a case of a previously healthy woman with acute COVID-19 infection, who developed acute facial nerve palsy and rapid progression to coma due to otogenic brain abscess.

Case Description A 63-year-old woman with acute COVID-19 infection exhibited acute facial nerve paresis, high fever, and purulent secretion from her left ear within 48 hours after COVID-19 onset. Cranial computed tomography scan confirmed acute mastoiditis, precipitating an urgent mastoidectomy. A postoperative contrast-enhanced magnetic resonance imaging on the same day revealed a subdural empyema, which prompted an urgent craniotomy and decompression. Intraoperative microbiological swabs confirmed a Streptococcus pyogenes infection; however, reverse transcription polymerase chain reaction was negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After immediate intravenous antibiotic treatment, extubation was achieved 4 days after operation, and the patient was discharged without neurological deficits 19 days after postoperatively.

Conclusion This finding adds a layer of insight into the specific nature of the infection, suggesting a potential absence of SARS-CoV-2 involvement in otogenic subdural empyema. However, the impact of SARS-CoV-2 in otogenic brain abscess cannot be excluded to date and should be further prospectively investigated. The complete recovery of neurological status emphasizes the importance of prompt and interdisciplinary interventions in managing rare and severe complications associated with COVID-19.

Keywords

coronavirus disease 2019 - facial nerve paresis - encephalitis - mastoiditis - subdural empyema

Consent to Participate

Informed consent was obtained from the patient.


Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


Authors' Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by D.D., S.-Y.W., F.G. and R.M. The first draft of the manuscript was written by A.R. S.T., B.B., S.B., C.B., D.A.R., L.Z., T.M.F. commented on previous versions of the manuscript. All authors read and approved the final manuscript.




Publication History

Received: 21 March 2024

Accepted: 19 November 2024

Accepted Manuscript online:
20 November 2024

Article published online:
26 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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