Session Information
Session Title: AA 2021 Virtual Posters - Pandemic
Session Time: None. Available on demand.
Disclosures: Todd J. Cooperman, MD: No financial relationships or conflicts of interest
Case Diagnosis: A 51 year old patient who had a prolonged and complex hospitalization related to a severe COVID-19 infection was admitted to an inpatient rehabilitation facility where he had recurrent aspiration pneumonia, malnutrition and hiccups and was ultimately diagnosed with cervical spine osteomyelitis and tracheoesophageal fistula.
Case Description: Rehabilitation was complicated by recurrent aspiration pneumonia and sarcopenia despite tube feedings and total parenteral nutrition. Bilateral wrist extensor weakness and autonomic dysreflexia raised suspicion of cervicothoracic spinal cord infarct from emboli due to COVID-19 hypercoagulability. Cervical/thoracic spinal MRI revealed C5/C6 discitis/osteomyelitis with phlegmon. He was treated with prolonged intravenous antibiotics. Modified barium swallow (MBS) revealed obstruction/narrowing just below the cricopharyngeus at C6/7 level or below. He was readmitted to the acute hospital for intractable nausea, vomiting and hiccups, CT abdomen/pelvis ruled out obstruction, attempts to manage his symptoms medically and by converting his PEG to PEJ (percutaneous endoscopic jejunostomy), were unsuccessful. MBS revealed a tracheoesophageal fistula (TEF) at C6/7. ENT deemed patient to be a poor surgical candidate. A second opinion with thoracic surgery was obtained, and stent was placed but subsequently was removed due to displacement caused by hiccups. He then underwent surgical repair of TEF. Postoperative MRI C spine revealed improvement of C5/6 infection and MBS revealed healing small TEF.
Setting: Inpatient Rehabilitation FacilityAssessment/
Results: This patient’s TEF, C5/6 osteomyelitis and hiccups are all sequelae of his COVID-19 infection.
Discussion: TEF has been linked to prolonged intubation in COVID-19 patients. Spondylodiscitis has been associated with TEF and hiccups can result from irritation of spinal nerve roots near “the hiccup center”, located between C3-5.
Conclusion: TEF and cervical spine infection should be considered in COVID-19 patients experiencing recurrent aspiration pneumonia, malnutrition and intractable hiccups.
Level of Evidence: Level V
To cite this abstract in AMA style:
Cooperman TJ, Lekshminarayanan A, Uddin MA, Bauer T, Campbell S, Licata JP, Kaufman M. Diagnosis of Tracheoesophageal Fistula and Cervical Spine Infection During Inpatient Rehabilitation in a Patient Recovering from COVID-19: A Case Report [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/diagnosis-of-tracheoesophageal-fistula-and-cervical-spine-infection-during-inpatient-rehabilitation-in-a-patient-recovering-from-covid-19-a-case-report/. Accessed September 7, 2024.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/diagnosis-of-tracheoesophageal-fistula-and-cervical-spine-infection-during-inpatient-rehabilitation-in-a-patient-recovering-from-covid-19-a-case-report/