This case shows that SARS-CoV-2 infection could present with a sudden neck swelling associated with pneumonia and rash, highlighting the need of an appropriate differential diagnosis in sudden lateral swelling of the neck in a pandemic context. We report our case highlighting this unusual presentation occurring in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To our knowledge, COVID-19 presenting with primary unilateral sudden neck swelling and rash due to edema of subcutaneous tissue, hypodermis, and muscular and deep fascial planes changes is unreported in the literature. Similarly, retropharyngeal fluid collection and peritonsillar or parapharyngeal abscess have been reported among the unique presentations of COVID-19. To date otolaryngologists have observed an increase in the number of patients with acute parotitis and submandibular gland sialadenitis, which could be related to CoronaVIrus Disease 19 (COVID-19) when associated to reported general and otolaryngologic symptoms, including fever, anorexia, arthralgia, myalgia, headache, fatigue, nasal obstruction, rhinorrhea, postnasal drip, sore throat, face pain, and loss of smell and taste. The differential diagnoses are acute sialadenitis, bacterial or viral cervical lymphadenitis, cellulitis, infected cyst, and neck hemorrhage from carotid blowout syndrome or extraglandular bleeding due to an underlying thyroid or parathyroid disease. The most common causes include acute infectious and inflammatory diseases. Non-traumatic sudden neck swelling is an emergency condition resulting from infectious and non-infectious conditions, and the emergency physicians and otolaryngologists should be able to determine its etiology. Sudden neck swelling with rash may be a coincidental presentation, but, in the pandemic context, it is most likely a direct or indirect complication of COVID-19. The patient was discharged after seven days in good clinical condition and with a negative swab. The neck swelling resolved in less than 24 h, while the erythema was still present up to two days later. The patient was treated with lopinavir/ritonavir, hydroxychloroquine and piperacillin/tazobactam for 7 days. This was confirmed by nasopharyngeal swab polymerase chain reaction. Both the anamnestic history of the patient’s husband who had died of COVID-19 with and the collateral findings of pneumonia and esophageal wall edema suggested the association with COVID-19. All the differential diagnoses were ruled out. Computed Tomography (CT) revealed a diffuse soft-tissue swelling and edema of subcutaneous tissue, hypodermis, and muscular and deep fascial planes. The patient reported COVID-19 symptoms over the previous three weeks. We report a case of a sudden neck swelling and rash likely due to late SARS-CoV-2 in a 64-year-old woman. Swollen lymph nodes.Although there are reports of otolaryngological symptoms and manifestations of CoronaVirus Disease 19 (COVID-19), there have been no documented cases of sudden neck swelling with rash in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection described in literature. doi:10.3389/fimmu.2018.00629Ĭenters for Disease Control and Prevention. BCG and adverse events in the context of leprosy. Richardus R, van Hooij A, van den Eeden SJF, et al. doi:10.1093/cid/civ061Ĭenters for Disease Control and Prevention. Adverse events following measles, mumps, and rubella vaccine in adults reported to the Vaccine Adverse Event Reporting System (Vaers), 2003-2013. Sukumaran L, McNeil MM, Moro PL, Lewis PW, Winiecki SK, Shimabukuro TT. ![]() Neck and supraclavicular lymphadenopathy secondary to 9-valent human papillomavirus vaccination. Immune response related to lymphadenopathy post COVID-19 vaccination. ![]() Generalized lymphadenopathy as the first manifestation of systemic lupus erythematosus. Soares L, Rebelo Matos A, Mello Vieira M, Cruz R, Caixas U. Mediastinal lymphadenopathy: A serious complication in COVID-19 patients. Khatri G, Priya, Saleem MB, Kumar A, Hasan MM. Impact of mediastinal lymphadenopathy on the severity of COVID-19 pneumonia: a nationwide multicenter cohort study. Mediastinal lymphadenopathy in patients with severe COVID-19. Association of mediastinal lymphadenopathy with COVID-19 prognosis. Sardanelli F, Cozzi A, Monfardini L, et al. Atypical otolaryngologic manifestations of COVID-19: A review.
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