Living in symbiosis with COVID: two delayed presentations of soft tissue infections in elderly patients with COVID-19 infection

Denis Gratsianskiy; Patrick K. Kiarie; Inhae Baek; Tyler Liguori; Nicole K. Nikolov; Martine A. Louis; Neil Mandava

doi:10.18203/2349-2902.isj20241146

Authors

Denis Gratsianskiy Department of Surgery, Flushing Hospital Medical Center, Flushing, New York
Patrick K. Kiarie St. George's University School of Medicine, Grenada, West Indies https://orcid.org/0009-0001-5636-3471
Inhae Baek St. George's University School of Medicine, Grenada, West Indies
Tyler Liguori New York Institute of Technology, Old Westbury, New York
Nicole K. Nikolov Ross University School of Medicine, Bridgetown, Barbados
Martine A. Louis Department of Surgery, Flushing Hospital Medical Center, Flushing, New York
Neil Mandava Department of Surgery, Flushing Hospital Medical Center, Flushing, New York

DOI:

https://doi.org/10.18203/2349-2902.isj20241146

Keywords:

Breast abscess, Retroperitoneal abscess, COVID-19 infection, Immune response, Immune dysfunction

Abstract

Retroperitoneal and extensive breast abscesses in elderly patients are associated with a significant burden of comorbidities, insidious symptoms, and signs resulting in delayed diagnosis. We present two elderly COVID-19-positive patients with retroperitoneal and breast abscesses. Both patients underwent multiple procedures and , despite a protracted course, survived each two potentially lethal infections. A 72-year-old man presented to the emergency department (ED) with back pain. Labs showed a polymerase chain reaction (PCR)-positive COVID-19 test and leukocytosis. A computed tomography scan of the abdomen and pelvis (CTAP) showed a perirectal abscess spreading into the pelvis and retroperitoneum. The patient underwent an incision and drainage (I and D). Additional imaging found multiple collections with extension into the retroperitoneum. These were drained, and the patient was discharged after repeat imaging showed resolution. A 78-year-old female was admitted with swelling of the right breast. Labs showed a positive PCR COVID-19 test, and chest computed tomography (CT) showed a rim-enhancing collection extending from the right breast into the right pectoralis muscle. The patient was started on antibiotics and underwent an I and D of the right breast. She was discharged on post-operative day (POD) four on antibiotics. She was readmitted 32 days later with a left sided abscess overlying the left pectoralis and was successfully treated conservatively with a course of antibiotics. There are few studies on the formation of abscesses in the breast and retroperitoneum in the setting of COVID-19 infection. Thus, information on the topic can aid physicians in maintaining clinical suspicion of severe abscesses illness in elderly patients presenting with vague clinical symptoms or symptoms concerning soft-tissue infections in the setting of COVID-19 infections

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