Tubercular Retropharyngeal Abscess With Pott’s Disease in an Elderly Male Patient

Abstract

Retropharyngeal abscess (RPA) is a life-threatening emergency due to its potential to cause airway compression. It is rare in the elderly and occurs mostly in immunocompromised patients, or as a complication of instrumentation. We are reporting the case of a 70-year-old male who presented with sudden onset breathing difficulty with a history of dysphagia for three months. The clinical examination revealed a bulge in the posterior pharyngeal wall. A lateralview radiograph of neck revealed retropharyngeal soft tissue density with carious spine. The patient was successfully treated by trans-oral incision and drainage of the abscess under local anesthesia. Diagnosis of tuberculosis was confirmed by positive acid-fast staining and cartridge-based nucleic acid amplification test (CBNAAT). The patient improved significantly following the initiation of anti-tubercular therapy.

A challenging diagnosis in a patient with Odynophagia

“…Neurological examination was normal and surgical drainage of the abscess was sufficient to cure together with medical treatment for two months with isoniazid, rifampicin, ethambutol, and pyrazinamide followed by other ten months with isoniazid and rifampicin without side effects. Retropharyngeal abscess commonly occurs in children due to suppurative infection of retropharyngeal lymph nodes [17] . Adult retropharyngeal abscess is unusual as these lymph nodes degenerate after the age of five years.…”

“…Adult retropharyngeal abscess is unusual as these lymph nodes degenerate after the age of five years. In adults, retropharyngeal abscess is often pyogenic and may result from penetrating injury, endotracheal intubation, foreign body or endoscopic procedures [17] . Retropharyngeal abscess is a rare entity in which Mycobacterium tuberculosis etiology is still present.…”

Tuberculosis espinal: diagnóstico y manejo

“…Está formado por un agregado de pus que se origina en las vértebras infectadas, sin o con poca respuesta inflamatoria circundante, que luego se aprovecha de la menor resistencia de tejidos blandos y, lentamente, pasa a los planos fasciales y neurovasculares (9,18) . En la columna cervical (10 %) aparece como un absceso retrofaríngeo que causa disfagia, ronquera y estridor respiratorio, y que puede seguir hasta el mediastino y comprometer la tráquea, el esófago o la cavidad pleural (27,28) . En la columna torácica (40-50 %) se presenta como una tumefacción paravertebral fusiforme, que puede seguir a través del ligamento arqueado o por los orificios del diafragma (3) .…”

Tuberculosis of the Cervical Vertebrae With Retropharyngeal and Parapharyngeal Abscesses Due to Staphylococcus aureus and Mycobacterium tuberculosis in an Adult: A Report of a Rare Case

“…It is mostly seen in the thoraco-lumbar region, followed by the cervical vertebrae [ 2 ]. Oftentimes, the infection of the cervical vertebrae by Mycobacterium tuberculosis results in the accumulation of pus in the retropharyngeal and parapharyngeal regions [ 3 ]. This is an emergency situation due to the potential for these abscesses to compress the airway [ 3 , 4 ].…”

“…Oftentimes, the infection of the cervical vertebrae by Mycobacterium tuberculosis results in the accumulation of pus in the retropharyngeal and parapharyngeal regions [ 3 ]. This is an emergency situation due to the potential for these abscesses to compress the airway [ 3 , 4 ]. It is usually seen in children below five years of age and is exceedingly rare after this age [ 3 ].…”