Bezold's Abscess in the Setting of Untreated HIV Infection

Abstract

Reports of Bezold's abscess are rare. Classically, Bezold's abscess is described as a complication of mastoiditis in which infection spreads deep to the sternocleidomastoid muscle and throughout the fascial planes of the neck. Antibiotic treatment of suppurative otitis media has considerably decreased the incidence of complications resulting from this disease. We present a unique case report of Bezold's abscess in the setting ofa patient with untreated HIV. To our knowledge, this is the first reported case of Bezold's abscess and HIV. Despite its rarity, clinicians must have a high suspicion for Bezold's abscess in the setting of complicated otitis media and HIV; it must be recognized early in immunocompromised patients and treated aggressively due to its potentially fatal outcome. Case report and review of the literature. We review the clinical course of a thirty five year old male HIV patient with a chronically draining ear and progressive neck stiffness, found to have a Bezold's abscess on CT. The incidence, pathogenesis and treatment of Bezold's abscess are discussed with special reference to the clinical presentation in the setting of an immunocompromised host. After broad-spectrum intravenous antibiotic therapy, mastoidectomy and surgical incision and drainage of the neck abscess, the patient recovered and had begun antiretroviral therapy at six-month follow-up. Bezold's abscess should be considered in the setting of complicated otitis media with neck stiffness and immunocompromised, specifically untreated HIV. The diagnosis and prompt, aggressive treatment of Bezold's abscess is necessary for an optimal clinical outcome