Retropharyngeal Tuberculous Abscess: A Rare Cause of Upper Airway Obstruction and Obstructive Sleep Apnea in Children: A Case Report.

Retropharyngeal tuberculous abscess (RPTBA) is a rare manifestation of tuberculosis (TB) even in high TB burden areas. It rarely manifests as a cause of upper airway obstruction and obstructive sleep apnea (OSA) in children with few case reports in the literature. We report a 22 months old toddler who presented with upper airway obstruction and OSA and was diagnosed with RPTBA. The child recovered completely and growing normally after intra-oral aspiration and 6 months of anti-tuberculosis treatment.

A Case of a Methicillin-Resistant Staphylococcus Aureus Retropharyngeal Abscess With Mediastinal Extension in an 11-Month-Old Girl.

We present the case of an 11-month-old girl with Mycoplasma pneumoniae-associated pneumonia who was subsequently diagnosed with a methicillin-resistant Staphylococcus aureus retropharyngeal abscess with mediastinal extension.

Community-acquired adult Escherichia coli meningitis leading to diagnosis of unrecognized retropharyngeal abscess and cervical spondylodiscitis: a case report.

BACKGROUND: Escherichia coli is a rare cause of community-acquired meningitis in adults unless predisposing factors are present (e.g., previous penetrating cranio-cerebral injury or neurosurgery, immunosuppression, chronic alcoholism, history of cancer, diabetes mellitus, advanced age). CASE PRESENTATION: We describe the case of a 53-year-old woman, resident in Germany, suffering from community-acquired bacterial meningitis caused by CTX-M-9 type extended spectrum ß-lactamase producing Escherichia coli. Because typical predisposing factors were not apparent, pathogen identification resulted in expanded diagnostics to exclude a distant or contiguous primary focus. By magnetic resonance tomography, a previously unrecognized large retropharyngeal abscess with cervical spondylodiscitis was detected. In retrospect, the patient had complained about neck pain for a few weeks prior to meningitis onset, but the symptoms were interpreted as being related to a herniated disk. Meningitis and osteomyelitis resolved completely under surgical treatment and meropenem therapy. CONCLUSION: In case of adult Escherichia coli meningitis, underlying diseases should always be carefully excluded, especially if predisposing factors are not apparent.

Severe infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus in infants: report of three cases and review of literature.

UNLABELLED: We report three cases of severe infections in infants caused by Panton-Valentine leukocidin positive Staphylococcus aureus and evolved with a positive outcome. The literature of Panton-Valentine leukocidin positive Staphylococcus aureus infections in infants is reviewed. CONCLUSION: Our findings suggest that a prompt identification of Panton-Valentine leukocidin positive Staphylococcus aureus and an appropriate therapy can reduce mortality and long-term sequelae. Further research is needed to specify features of Panton-Valentine leukocidin positive Staphylococcus aureus infections in infants.

Tuberculous retropharyngeal abscess presenting with symptoms of obstructive sleep apnea.

Chronic retropharyngeal abscess (RPA) caused by tuberculosis is an uncommon manifestation of extrapulmonary tuberculosis within the head and neck. Obstructive sleep apnea (OSA) in adults is a common condition with many etiologies that have been well described. Here, we present a case of retropharyngeal abscess caused by chronic tuberculosis with an unusual and interesting presenting symptom in an adult that has not been mentioned in literature, new-onset and worsening stertor or snoring, with signs and symptoms of OSA. The purpose of this manuscript is to present our experience with this case, as well as to emphasize the diagnosis, clinical course, and management of tuberculous retropharyngeal abscess in adults, while also signifying the need to include retropharyngeal abscess in the differential diagnosis for symptoms presenting as new-onset stertor and airway obstruction.

Retropharyngeal cold abscess without Pott's spine.

Retropharyngeal abscesses are infections deep in the neck space that can pose an immediate life-threatening emergency, with potential for airway compromise and other catastrophic complications. In adults these abscesses can develop as a result of vertebral pyogenic osteomyelitis, tuberculosis of the spine, or external injuries caused by endoscopes or foreign bodies (e.g. fish bones). Tuberculosis of the retropharyngeal space is one of the rare forms of extrapulmonary tuberculosis. Early diagnosis and treatment are necessary to prevent the serious complications of the disease. We present a case of tuberculous retropharyngeal abscess in an adult woman without tuberculosis of the cervical spine who was managed surgically by aspirating the retropharyngeal abscess transorally, together with antituberculosis treatment.

Retropharyngeal abscess in adults.

OBJECTIVES: Retropharyngeal abscess in adults can be life-threatening. The otolaryngologist is on the front line in making the diagnosis and treatment of this disease. The aim of this study is to review the clinical features, the diagnostic tools and the management of retropharyngeal abscesses in adults. PATIENTS AND METHODS: Retrospective study of retropharyngeal abscesses in adults admitted in the ENT department from 2005 to 2010. RESULTS: In total 4 patients were included in this study: mean age of 53 years (range 45 to 62 years), sex ration F/M = 3. Cultures obtained from the abscesses identified group A beta-hemolytic streptococci susceptible to amoxicilline-clavulanate in three cases. The treatment consisted in surgical drainage of the collection and intravenous antibiotics. CONCLUSIONS: Retropharyngeal abscesses in adults are critical infections requiring prompt diagnosis and treatment. Computed tomography scan was the crucial tool for the diagnosis, notably to differentiate cellulitis from abscesses. The management includes intravenous broad-spectrum antibiotics associated, if necessary, with surgical drainage in cases of persistent abscess. The outcome is usually good.

Pediatric deep neck infections: Clinical description and analysis of therapeutic management.

OBJECTIVES: The aim of our study was to describe clinical presentations, bacteriological results, and therapeutic management in a pediatric population presenting with acute pharyngeal suppuration. A further aim was to identify clinical, bacteriological, and radiological predictors of success associated with exclusive medical treatment. METHOD: A retrospective study was carried out including patients under 18 years of age hospitalized between January 1, 2015 and December 31, 2017 in our center for acute pharyngeal suppuration. We identified three groups of patients: group A, treated with exclusive intravenous antibiotics; group B, surgically treated after 48 h of appropriate antibiotic therapy, due to persistent fever and/or clinical worsening and/or persistence of a collection on follow-up imaging; group C, surgically treated as first-line therapy in association with intravenous antibiotics. A total of 83 patients were included: 36 in group A, 12 in group B, and 35 in group C. These three groups were compared for several variables: age of the patients, polynuclear neutrophil counts, diameter of the collections (the largest diameter found on imaging), duration of antibiotic therapy, delay before return to apyrexia, and hospitalization duration. RESULTS: A neck mass and torticollis were present, respectively, in 48.8 and 47.6% of cases. No breathing difficulties were reported. Streptococcus pyogenes was the most frequently identified microorganism. The average diameter of the collections from patients treated surgically as first-line therapy (group C) was significantly larger than that of the patients treated with antibiotics (group A) (27.89 mm vs. 18.73 mm, respectively, p = 0.0006). All the patients who required surgery despite 48 h of appropriate antibiotic therapy (group B) had collections with diameters greater than or equal to 15 mm. There was no significant difference between the groups concerning hospitalization duration. CONCLUSION: Exclusive medical treatment is associated with a high cure rate, mainly for collections with small diameter. We recommend special attention to patients treated with first-line exclusive intravenous antibiotic therapy and with a collection diameter greater than or equal to 15 mm.

An atypical case of retropharyngeal abscess with long blind tract treated with Ryle's tube drainage.

A 10 year-old Iban girl presented with severe odynophagia for 4 days and subcutaneous emphysema. Clinically, her neck was tender with crepitus. Lateral neck radiograph showed multiple linear radiolucent shadows at retropharyngeal space. Flexible nasopharyngolaryngoscope revealed a tunnel behind upper oesophagus with slough and there was pooling of saliva at pyriform sinus. Feeding via nasogastric tube was started and empirical treatment for fungal and bacterial infection was commenced. Subsequent computed tomography of neck and thorax showed a 15-long blind tract at subglottic region posterior to oesophagus (prevertebral region), extending to superior mediastinum just before carina at T3/T4 level, represent abscess. Hourly suctioning of the remaining abscess in the blind tract with 10ml-syringe was done.

[Retropharyngeal abscess in an adult patient complicated by purulent meningoencephalitis].

The authors report a case of successful treatment of an adult woman presenting with retropharyngeal abscess complicated by purulent meningoencephalitis. Peculiarities of diagnostics and treatment of retropharyngeal abscess in adult patients are discussed.

Iliosacral bacterial arthritis and retroperitoneal abscess after tension-free vaginal mesh reconstruction.

A 64-year-old woman presented with severe infection accompanied by iliosacral arthritis and retroperitoneal abscess after tension-free vaginal mesh reconstruction using polypropylene meshes (GyneMesh; Gynecare, Ethicon, Somerville, NJ, USA) for pelvic organ prolapsed quantification of stage 3 pelvic organ prolapse. Three weeks after the operation, she complained of high fever (39 degrees C) and sharp pain from the left buttock down to the left lower limb. Computed tomography revealed a retroperitoneal abscess and osteolysis caused by iliosacral arthritis. Because the infection was not resolved by drainage and antibiotic therapy, the left portion of the mesh was removed. She recovered after mesh removal, and no recurrent abscess was observed in the CT after a 6-month follow-up. However, the patient complained of sporadic discomfort in the left buttock, and a blood examination performed during this period, revealed a slight elevation in the C-reactive protein level. Although this symptom was resolved by oral antibiotics, further follow-up was required.

Horner's syndrome as a co-presentation of tuberculous retropharyngeal abscess.

Tuberculosis is a disease known to affect any part of the body and to present in many interesting forms. A case of tuberculous retropharyngeal abscess is described here presenting with odynophagia and Horner's syndrome. Horner's syndrome as a presenting feature of tuberculous retropharyngeal abscess has never been reported in Pakistan.

[Cutaneous periarteritis nodosa recurring over a period of 30 years in streptococcal infections and progressing toward systemic vasculitis]. / Périartérite noueuse cutanée récidivant depuis 30 ans lors d'infections streptococciques et évoluant vers une vascularite systémique.

INTRODUCTION: Periarteritis nodosa (PAN) is a form of vasculitis affecting the small and medium-sized arteries. Below, we report a case of cutaneous PAN relapsing in streptococcal infections over a period of 30 years and progressing towards systemic vasculitis. CASE REPORT: A 35-year-old man was hospitalised for a retro-pharyngeal access associated with fever, arthralgia, myalgia and inflammatory subcutaneous nodules. Peripheral neurological signs were also seen with deficiency of the elevator muscles in the right foot. Examination of a biopsy from a nodule showed a characteristic image of PAN. Following drainage of the abscess, a favourable outcome was obtained with antibiotics and systemic corticosteroids. History taking showed that the patient had presented similar episodes since the age of 5 years involving arthralgia, myalgia and inflammatory subcutaneous nodules. These episodes appeared to follow a streptococcal infection, of which there was either clinical suspicion or objective elevation of antistreptolysin O (ASLO) titre. Skin biopsy resulted in diagnosis of cutaneous PAN 25 years earlier. In all cases, improvement was achieved by oral corticosteroids combined with treatment of the actual infection. DISCUSSION: In addition to the classic association with hepatitis B, and occasionally hepatitis C, PAN may be associated with streptococcal infections. The cases of post-streptococcal PAN described in the literature are predominantly cutaneous, although it is not rare to find associated arthromyalgia and sensory neurological impairment. We examined three cases of cutaneous PAN with long-term follow-up described in the literature. They began in childhood and the outcome was benign, with no systemic manifestations. Our case differed in terms of the appearance of motor neurological involvement. CONCLUSION: Post-streptococcal PAN of childhood onset generally carries a better prognosis than adult systemic forms. However, our case shows that on rare occasions, there may be very long progression complicated by systemic involvement.

[A fatal case of dermatomycoses with retropharyngeal abscess]. / Un cas de maladie dermatophytique fatale par abcès rétropharyngé

BACKGROUND: Dermatophytic disease is a rare chronic infection caused by dermatophytes and characterised by cutaneous and visceral invasion. It is observed in North Africa. It is associated with cellular immunodeficiency and refractoriness to drug treatment. CASE REPORT: We report a new case of dermatophytic disease in a 26-year-old Tunisian woman. The patient's parents were first cousins; no other family members had a similar disease state. At the age of 3 years, the patient developed extensive tinea corporis associated with onychomycosis resistant to the usual antifungal drugs. The patient was hospitalised for multiple subcutaneous vegetative and ulcerative lesions of the scalp, face and chest associated with multiple adenopathies, occasionally fistular, of the axillary, cervical, mammary and inguinal areas. Mycology and histology confirmed the presence of fungal hyphae. Trichophyton violaceum was isolated in cultures of various skin lesion and lymph node biopsy samples. Investigations showed no evidence of immunodeficiency. Although the patient initially responded well to itraconazole (Sporanox, 400 mg/day), her condition worsened with obstruction and dyspnoea due to retropharyngeal pus collection requiring repeated surgical evacuation, and ultimately leading to a fatal outcome. DISCUSSION: Dermatophytic disease remains a severe disease due to the possibility of potentially life-threatening visceral involvement and antifungal drug resistance.

Fatal retropharyngeal abscess: a possible marker of inflicted injury in infancy and early childhood.

UNLABELLED: Retropharyngeal abscesses are serious infections of the deep tissues of the neck associated with significant morbidity and mortality due to their proximity to vital structures. The most common age range is 2-4 years, with neonates accounting for approximately 10% of cases. The following report demonstrates possible forensic issues that may arise in such cases. CASE REPORT: A 10-week-old infant was found dead in her father's arms an hour after feeding. At autopsy death was due to a large retropharyngeal abscess with disseminated Streptococcus pneumoniae sepsis. Other findings at autopsy of bruising and multiple fractures of the ribs and limbs indicated inflicted injury; this raised the possibility that the abscess had arisen from forceful foreign body insertion into the pharynx. The mortality and complication rates of retropharyngeal abscess remain high even with the institution of appropriate treatment; however, the wide variety of presentations often causes delays in diagnosis and treatment. When found at autopsy in infants and children the possibility of inflicted injury should be considered.

Tuberculous retropharyngeal abscess with Pott disease and tuberculous abscess of the chest wall: A case report.

RATIONALE: Tuberculous retropharyngeal abscess is rare, but it can be fatal if not treated appropriately. It usually occurs secondary to tuberculosis of the cervical spine. Moreover, tuberculous abscess involving the chest wall is relatively rare in skeletal tuberculosis. Although the optimal treatment is controversial, most clinicians suggest a combination of sufficient antituberculous medication and complete resection to prevent recurrence and increase therapeutic efficacy. Herein, we present an unusual case of retropharyngeal abscess with cervical Pott disease and tuberculous abscess of the chest wall. PATIENT CONCERNS: The patient was a 27-year-old Indonesian woman who had neck pain, dysphagia, and odynophagia, but no neurological deficit. Examination of the oral cavity showed anterior displacement of the posterior pharyngeal wall. The mass over the right anterior chest wall measured approximately 5 × 4 cm in size. DIAGNOSES: Radiography and computed tomography findings were suggestive of retropharyngeal abscess extending to the cervical spine and chest wall abscess. INTERVENTIONS: She was admitted to the hospital for treatment. Drainage of the retropharyngeal and chest wall abscesses with debridement of the chest wall was performed. OUTCOMES: No complications occurred after early surgical treatment and administration of antituberculous medication. The patient recovered well and went back to her own country after discharge. LESSONS: Tuberculous retropharyngeal abscess with Pott disease and tuberculous abscess of the chest wall are both complicated diagnoses that physicians have to consider in similar patient presentations.

Clinical features and treatment of retropharyngeal abscess in children.

OBJECTIVE: To characterize presentation, treatment, and outcomes of pediatric retropharyngeal abscess (RPA) and determine optimal treatment. STUDY DESIGN: Retrospective cohort. SUBJECTS AND METHODS: Chart review of 162 pediatric patients with RPA. RESULTS: Initial treatment was surgery in 126 and intravenous antibiotics in 36, of which 17 required surgery. Findings were negative in 30, murky fluid in 34, and pus in 79. Factors predicting positive surgical drainage were duration of symptoms for more than 2 days, prior antibiotic treatment, and CT lesion cross-sectional area >2.0 cm(2). A history of rash was a negative predictor. The mean length of stay (LOS) was 4.8 vs 3.6 days (P = 0.14), and duration of fever (DOF) was 2.5 vs 1.4 days (P = 0.01) for patients with no fluid and fluid at surgery, respectively. For antibiotic vs surgery groups, LOS was 4.4 vs 3.6 days (P = 0.14) and DOF was 2.4 versus 1.5 days (P = 0.0061). CONCLUSIONS: These predictive factors may be useful in selecting patients with retropharyngeal abscesses who might be treated with intravenous antibiotics alone.