SHM Converge Scientific Abstract ePoster Gallery-Cavernous Sinus Thrombosis in a 20-Year-Old Covid-19 Patient

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This case report describes a 20-year-old man with COVID-19 who developed cavernous sinus thrombosis (CST) and subdural empyema. He initially presented with one week of fever, headache, and nasal congestion, then rapidly worsened with left eye proptosis, photophobia, and altered mental status. Laboratory findings showed marked inflammation, leukocytosis with neutrophilia, and prolonged prothrombin time. MRI confirmed left post-septal cellulitis, a subperiosteal abscess, left superior vein thrombosis, cavernous sinus thrombosis, and concern for subdural empyema.<br /><br />The report emphasizes that COVID-19 can create a hypercoagulable state through endothelial injury, inflammatory activation, blood stasis, and elevated coagulation markers such as D-dimer, fibrinogen, and von Willebrand factor. It also highlights that bacterial superinfection can spread through valveless venous pathways to the cavernous sinus, causing severe intracranial complications.<br /><br />Treatment included urgent ophthalmologic and neurosurgical interventions, broad-spectrum IV antibiotics, anticoagulation with argatroban followed by apixaban, and craniotomy with evacuation of the empyema. Blood and empyema cultures grew polymicrobial organisms, including Fusobacterium species, leading to a switch to meropenem for six weeks. The patient improved, was extubated, and remained on oral apixaban.<br /><br />Overall, the case underscores the need to recognize COVID-19 not only as a respiratory illness but also as a condition associated with thrombotic risk and possible serious bacterial superinfection.

Asset Subtitle

Camryn Keller

Meta Tag

Author List Akhilesh Thakur, Camryn Keller

Category Clinical Vignettes

Concept COVID-19 Infection

Concept Cavernous Sinus Thrombosis

Concept Hypercoagulable State

Concept Venous Thromboembolism

Concept Intracranial Subdural Empyema

Distinguished Non-Finalist

Presenter Organization Louisiana State University Health Sciences Center- Shreveport

Presenting Author Camryn Keller

Track Adult

Keywords

COVID-19

cavernous sinus thrombosis

subdural empyema

hypercoagulable state

bacterial superinfection

orbital cellulitis

subperiosteal abscess

anticoagulation

meropenem

Fusobacterium

COVID-19 Infection

Cavernous Sinus Thrombosis

Hypercoagulable State

Venous Thromboembolism

Intracranial Subdural Empyema