Epidural Abscesses as a Complication of Interleukin-6 Inhibitor and Dexamethasone Treatment in a Patient with COVID-19 Pneumonia: A Case Report

A 66-year-old female patient was hospitalized with severe COVID-19 pneumonia, which led to hypoxia requiring oxygen support with high-flow nasal cannulae. She received anti-inflammatory treatment with a 10-day dexamethasone 6 mg PO course and a single infusion of IL-6 monoclonal antibody tocilizumab 640 mg IV. Treatment led to gradual reduction of oxygen support. However, on Day 10, she was found to have Staphylococcus aureus bacteremia with epidural, psoas, and paravertebral abscesses as the source. Targeted history taking revealed a dental procedure for periodontitis 4 weeks prior to hospitalization as the probable source. She received an 11-week antibiotic treatment, which led to resolution of the abscesses. This case report highlights the importance of individual infection risk assessment before the initiation of immunosuppressive treatment for COVID-19 pneumonia.