Extensive deep neck infection associated with acupuncture

Abstract

Deep neck infections are rare but potentially lethal conditions that require prompt identification and management. They can occur in the peritonsillar, submandibular, parapharyngeal and retropharyngeal spaces. The most affected areas tend to differ by age, with tonsillitis being more common in children and odontogenic in older adults. Predisposing factors to infection can also influence location. Early treatment is paramount as airway compromise, septic shock and extension to adjacent structures can lead to morbidity and mortality. Here we report a case of extensive deep neck infection in an elderly diabetic patient with multiple abscesses involving the paraspinal space and extending anteriorly close to the carotid sheet, yet without airway compromise or hemodynamic instability. After further questioning, the likely mode of infection was identified as acupuncture in the affected region. We present a review of the presentations, differential diagnoses, treatments, and clinical course of adults with deep neck infections to highlight the importance of expeditious diagnosis and treatment.