Abstract
Retropharyngeal abscess is acute suppurative infection of the retropharyngeal space. Most commonly it occurs in children younger than four years of age having history of streptoccocal pharyngitis. Clinical presentation similar to epiglottitis or foreign body aspiration makes distinguishing issues so the diagnosis of retropharyngeal abscess can initially be missled. Here we are illustrating four month old female infant with incipient presentation that clinically resembles epiglottitis. After the initial management in the intensive care unit clinical work-up was continued with multidysciplinary collaboration and the diagnosis of retropharyngeal abscess was given, treated both surgically and conservatively. Postoperative intensive care was then continued with subsequent clinical and biochemical improvement. This case demonstrates the need for broad thinking when dealing with affebrile child being respiratory distressed and during diagnostic work-up of a patient having fever of unknown origin.
Highlights
Retropharyngeal abscess is suppurative infection located in retropharyngeal space between the pharynx and the cervical vertebrae, which can be extending through upper parts of mediastinum
Dramatical respiratory distress with drooling, dysphagia, odynophagia, cervical lymphadenopathy, torticollis [11], unilateral neck and pharyngeal wall swelling is mostly present in children with deep neck infections
Therapy is continued in the pediatric intensive care unit
Summary
Retropharyngeal abscess is suppurative infection located in retropharyngeal space between the pharynx and the cervical vertebrae, which can be extending through upper parts of mediastinum. Upon receipt laboratory studies showed following values – WBC 12.7, segmented PMN 29, bands 0, lymphocytes 53, monocytes 15%, CRP 6.5 mg/L, ESR (erythrocyte sedimentation rate) 40 mm/3.6 ks, RBC, Hb, HCT and other biochemical findings neat value for age. 24 hours later she was extubated with no respiratory problems Laboratory findings during her stay were: WBC 19.6, segm PMN 78%, Ly 19.6, Mo 3.5, CRP 10.5...21...10.7 mg/L, ESR 80...50 mm/3.6 ks, total proteins 70 g/l, albumin/globulins 17.01, albumin 54.9, alpha-1-globulins 3.5, alpha-2 globulins 11.3, beta-globulins 8.4, gammaglobulins 22.9 g/L (persistently elevated) with neat values of RBC, Hb, HCT, platelets and other biochemical values and coagulogram. After the consultation with pediatric infectologist child was treated with both cephazoline and clindamycin and given other symptomatic therapy After both surgical and antibiotic therapy prompt recovery and improvement of the clinical status and laboratory findings were witnessed.
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