Transient perivascular inflammation of the carotid artery (T
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A 36-year-old man with moderate-to-severe left neck pain, local swelling, and tenderness was seen at the emergency room. Over the prior 4 days he had received beta-lactam antibiotic therapy with no improvement. One month before he experienced mild symptomatic COVID-19. The PCR-based test performed at the emergency room resulted still positive. The remaining personal history was negative; the routine laboratory parameters were within reference range and autoimmunity screening results were negative.

A carotid ultrasonography demonstrated eccentric hypo-/isoechoic smooth abnormal soft tissue surrounding the carotid artery bifurcation and in the proximal internal carotid artery with a thickness diameter of 5 mm and a median length of 2 cm. No hemodynamically relevant stenosis or atherosclerotic plaques were present. A nuclear magnetic
resonance confirmed the ultrasonographic findings concerning the size of the lesion and showed local contrast enhancement, as well as reactive lymphadenopathy, suggesting a focal vasculitis.

A Computed tomography angiography showed no thrombosis or carotid artery dissection and a Positron Emission Tomography did not show pathological areas of increased uptake along other vessels. The patient received levofloxacin for 5 days as well as pain killers. After one month, he was asymptomatic and a subsequent ultrasonographic exam showed no alterations of the carotid arteries.

In this patient, the final diagnosis of transient perivascular inflammation of the carotid artery (TIPIC) syndrome (previously known as “carotidynia”) was made.

To the best of knowledge, this represents the first published case of TIPIC syndrome associated with COVID-19. SARS-CoV2 causing COVID-19 can promote endothelial cell infection and inflammation. The carotid body could be a site of virus invasion due to local expression of angiotensin converting enzyme receptors. Although no causal relationship between COVID-19 and TIPIC syndrome can be demonstrated in this individual patient, our observation should serve to generate hypotheses and must be confirmed in future studies with an appropriate design and size.