Successful management of Kikuchi-Fujimoto disease caused by SARS-CoV-2 / SARS-CoV-2-fertozés okozta Kikuchi-Fujimoto-betegség sikeres gyógyítása

The Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis) is an autolimited process, which can be caused by viral agents like Epstein-Barr virus, human herpes virus, HIV, B19 parvovirus, paromyxoviruses, SARS-CoV-2, Toxoplasma and Yersinia. The correct diagnosis is based on histological findings. A 45-year-old female patient presented in our ambulatory room with a unilateral neck mass, fever, dysphonia and dysphagia. The patient was double-tested positive for SARS-CoV-2 approximately 1 month before the symptoms started. Before examination, the nasopharyngeal rapid test for SARS-CoV-2 resulted negative. After hospitalization, intravenous antibiotic (Augmentin, 3 x 1.2 g; Klion, 2 x 100 mg) and steroid (Solu-Medrol, 2 x 125 mg) therapy were administered. The neck and chest CT described a right-sided retropharyngeal abscess with bilateral neck lympadenopathy. Urgent tracheotomy, neck dissection and lymph node biopsy were made. The intraoperative findings excluded the presence of the abscess. The histological findings confirmed the necrotizing histiocytic lymphadenitis. Despite of the fact that the Kikuchi-Fujimoto disease is autolimited, we can see that, in this particular case, the lymphadenopathy after the SARS-CoV-2 infection caused a life-threatening situation. The formed extratissular liquid imitated the image of a retropharyngeal abscess. In the searched worldwide literature, similar intervention for this type of process was not described. Tracheotomy, neck dissection and removing the lymph nodes as ,,trigger zones used the full recovery of the patient. In the future, we consider important proving and clarifying the correlation between SARS-CoV-2 and Kikuchi-Fujimoto disease.

Retropharyngeal abscess as a paradoxical reaction in a child with multi-drug-resistant tuberculosis.

Paradoxical reactions (PRs) are exaggerated inflammatory responses owing to recovery of cellular immunity following initiation of anti-tuberculous therapy (ATT). The presentation is worsening of pre-existing symptoms or development of new lesions. A 14-year-old girl with multi-drug-resistant tuberculosis developed a recurrent asymptomatic retropharyngeal abscess while on ATT. She required multiple aspirations of the abscess. Xpert MTB/RIF detected Mycobacterium tuberculosis from the aspirate which was resistant to rifampicin; culture was negative. Following aspirations of the abscess, continued ATT and a 2-month course of corticosteroids, she remains well and has gained weight. A retropharyngeal abscess presenting in the form of a PR has not been reported previously in adults or children.

Large retropharyngeal abscess: a case of mistaken identity.

We report an unusual case of nasopharyngeal carcinoma (NPC), presenting initially as a retropharyngeal collection. We discuss the investigation, diagnosis and management of NPC and furthermore review the literature of NPC, emphasising the varied presentation. A 44-year-old Caucasian male ex-smoker presented with a 10-day history of a painless left-sided neck lump; progressive dysphagia and unintentional weight loss. Examination demonstrated a large left posterior pharyngeal swelling with soft palatal effacement, confirmed on nasoendoscopy. A CT scan revealed a fluid collection in the retropharyngeal space, which partially occluded the nasopharynx, and numerous satellite lesions were identified along with cervical lymphadenopathy. The suspected abscess was drained in theatre and nasopharyngeal biopsies were taken. These revealed Epstein-Barr virus-positive NPC. Staging investigations revealed a T4N2M0l carcinoma. Treatment consisted of radical chemoradiation therapy with curative intent. NPC is known for its varied and late presentation, and is an important condition to be aware of when considering a differential diagnosis of pharyngeal masses.

[Deep neck infection: clinical analyses of 95 cases].

OBJECTIVE: To review the recent diagnosis and treatment experience with deep neck infection and emphasize the importance of radiologic evaluation, microbiology and appropriate treatment selection in these patients. METHODS: A respective review was conducted in 95 cases who were diagnosed as having deep neck from Jan. 2006 to March 2015. RESULTS: The primary diseases in 95 patients with deep neck infection were acute tonsillitis or acute laryngitis (27 cases), infection of upper respiratory tract (23 cases), odontogenic infection or oral inflammation (16 cases), foreign bodies in esophagus (9 cases), acute cervical lymphadenitis (5 cases) and cause uncertain (15 cases). Computed tomography was performed in all of patients to identify the location, extent, and character (cellulitis in 47 cases or abscesses in 48 cases) of the infections. The locations of abscess were parapharyngeal abscess (25 cases), retropharyngeal abscess (9 cases), submaxillary space abscess (6 cases), pretracheal space abscess (5 cases) and esophageal abscess (3 cases). COMPLICATIONS: mediastinitis (2 cases), pericarditis (1 case), bilateral pneumothorax (2 cases), and upper digestive tract (1 case). Bacterial cultivation performed in 35 patients and positive results were detected in 21. All patients were given intravenous antibiotic therapy. Tracheotomy was performed in 4 cases. Preoperative contrast enhanced CT was performed in 42 patients and indicated the formation of abscess. Three cases with the symptoms of septic shock were transferred to ICU and one was cured. All the patients were cured except two who died of massive hemorrhage of upper digestive tract and septic shock. CONCLUSIONS: The airway patency in patients with deep neck infections must be ensured. Drainage may be mandatory in selected cases at presentation or in cases who fail to respond to parenteral antibiotics within the first 24-48 hours. Imaging evaluation plays a significant role in the diagnosis and rational therapeutic management in deep neck infection. Bacterial cultivation can help to make the effective treatment and provide reliable evidence for the etiopathogenisis.

Staphylococcus aureus retropharyngeal abscess in children.

A retrospective review of 33 patients comparing community-associated methicillin-resistant Staphylococcus aureus retropharyngeal abscess (RPA) with community-associated methicillin-susceptible S. aureus RPA from 2002-2013 at Texas Children's Hospital revealed most cases of S. aureus RPA have been due to community-associated methicillin-resistant S. aureus, which appears to be associated with a more complicated clinical course than RPA caused by community-associated methicillin-susceptible S. aureus.

Retropharyngeal abscess with carotid involvement presenting as fever of undetermined origin in a dog.

A young dog was presented with lethargy and pyrexia of 2 days duration, not responding to empirical treatment. Thorough diagnostic investigation failed to determine the cause. A retropharyngeal abscess became apparent when it eroded into the carotid artery 2 days later. This case highlights the challenging nature of fever of undetermined origin (FUO) and the value of close monitoring for diagnosis and prompt intervention.

Abcès rétro-pharyngien avec une atteinte de la carotide et une fièvre d'origine indéterminée chez un chien. Un jeune chien a été présenté pour un abattement et une pyrexie d'une durée de 2 jours et il ne répondait pas au traitement empirique. Une enquête diagnostique complète n'a pas réussi à déterminer la cause. Un abcès rétro-pharyngien est devenu apparent lorsqu'il s'est érodé dans la carotide 2 jours plus tard. Ce cas souligne la nature difficile d'une fièvre d'origine indéterminée et la valeur d'une étroite surveillance pour le diagnostic et une intervention rapide.(Traduit par Isabelle Vallières).

Neck swelling from a retropharyngeal abscess caused by penicillin-resistant Streptococcus pneumoniae: a case report.

BACKGROUND: In small children, retropharyngeal abscesses usually occur after upper respiratory tract infections. Unlike in adults, these abscesses are difficult to diagnose in small children, and can rapidly develop into deep neck or mediastinal abscesses. CASE PRESENTATION: A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling. Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall. Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck. The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess. After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma. The lesions improved after intraoral incision and drainage, and administration of antibiotics. CONCLUSION: Lymphangiomas and retropharyngeal abscesses are both known to be more common in children than in adults. However, we found no other reports of concomitant presentation of lymphangioma and retropharyngeal abscess in the literature.

Retropharyngeal abscess revealing a migrant foreign body complicated by mediastinitis: a case report.

Pharyngeal foreign bodies are quite common. Their diagnosis is usually easy. The risk of complications including retropharyngeal abscess and mediastinitis is rare and it depends mainly on the nature of the foreign body and the period of the therapeutic management. The occurrence of these complications darkens the prognosis of this affection usually benign. We report a 21 years old patient, without any significant history, admitted to the emergency for a high painful dysphagia and impaired general condition with fever 20 days after trauma in the posterior pharyngeal wall following a meal. The radiological assessment including cervico-thoracic CT scan had objectified the presence of a metallic foreign body in the retropharyngeal space associated with a retropharyngeal abscess and aggravated by a mediastinitis following the migration of the foreign body to the chest. Biological markers of infection were very increased. The therapeutic management consisted of a surgical drainage of the collections by a cervicotomy with removal of the foreign body. The outcome was favorable clinically and biologically. Pharyngeal foreign bodies are common and favorable when the diagnosis and extraction are made on time. The occurrence of complications, especially retropharyngeal abscess and mediastinitis is rare and burdened with a high morbidity and mortality.

Fatal case of retropharyngeal abscess associated with Pott's disease.

Retropharyngeal abscess is a rare, deep seated infection of the neck that usually affects young children. Chronic retropharyngeal abscess is rare and results from tuberculosis of the spine. Such swelling in the neck gradually increases in size and is detected during the routine radiological screening for symptoms like pain, dysphagia, fever, dyspnoea, progressive inspiratory stridor (from laryngeal obstruction), neck hyperextension etc, but rarely leads to sudden death due to airway obstruction. Thus the forensic pathologist rarely comes across such type of cases. Present case concerns obstruction of upper airway by a large retropharyngeal cold abscess leading to death in a 13-year-old female child from a lower socio-economic family. The possible explanation for the progression and fatal outcome of such abscesses associated with the Pott's disease is being discussed in the light of available literature.

Predictors for successful treatment of pediatric deep neck infections using antimicrobials alone.

Among hospitalized children with parapharyngeal or retropharyngeal infection, multivariate analysis was performed for the outcomes: successful treatment with antibiotics alone, absence of complications and length of stay less than 3 days. Those with apparent abscess on computed tomography scan had a lower probability of treatment with antimicrobials alone while older age was associated with increased probability of treatment with antibiotics alone.

Incomplete Kawasaki disease with intermittent fever and retropharyngeal inflammation.

Kawasaki disease is a systemic vasculitis of unknown etiology, presenting typically in infants and young children. We report a rare case of incomplete Kawasaki disease in a 15-month-old male infant presenting with symptoms mimicking retropharyngeal abscess and intermittent fever.

Tuberculous retropharyngeal abscess without cervical spine TB.

Tuberculous retropharyngeal abscess is a rare presentation. It is present in adults usually due to involvement of cervical spine by tuberculosis. Retropharyngeal space usually gets involved in children due to pyogenic organisms or secondary to trauma. Here is a case of tuberculous retropharyngeal abscess in an adult female, with pulmonary tuberculosis. The patient was not having tuberculous involvement of cervical spine and was managed surgically by aspirating the retropharyngeal abscess transorally and AKT Category I.

Arcanobacterium haemolyticum in a badger (Meles meles).

A 7.5-kg female European badger (Meles meles) was submitted under the United Kingdom Government's Wildlife Incident Investigation Scheme to the Thirsk Regional Laboratory of the Animal Health and Veterinary Laboratories Agency. Postmortem examination revealed a large, poorly encapsulated retropharyngeal abscess full of necrotic debris and pus. Arcanobacterium haemolyticum was isolated from the lymph node and confirmed by phenotypic profiling and 16S ribosomal RNA DNA sequencing. Workers should be aware of the potential for badgers to harbor zoonoses other than those more traditionally associated with the species.

Kawasaki disease mimicking retropharyngeal abscess.

Kawasaki disease is an acute, self-limiting febrile mucocutaneous vasculitis of infants and young children. Retropharyngeal lymphadenopathy is a rare presentation of Kawasaki disease. We present a case of Kawasaki disease mimicking a retropharyngeal abscess, with upper airway obstruction resulting in delayed diagnosis.

A new technique for intraoperative reduction of occipitocervical instability.

BACKGROUND: Occipitocervical instability with vertical migration of the odontoid is a rare but potentially debilitating anomaly of the craniocervical junction. Anterior decompression by means of a transoral or transcervical approach followed by posterior instrumentation commonly is used to treat this pathology. OBJECTIVE: To develop an innovative operative technique to correct reducible occipitocervical instability using a purely posterior approach. CLINICAL PRESENTATION: Two patients presented to our institution with occipitocervical instability. One patient developed vertical migration of the odontoid secondary to a retropharyngeal abscess after radiation treatment. The second patient developed occipitocervical instability as a result of pathological destruction of C2 from a breast metastasis. Both patients were myelopathic with severe neck pain. TECHNIQUE: Both patients were brought to the operating room for intraoperative reduction and fixation using a purely posterior approach. This new technique obviated the need for an anterior decompression procedure or preoperative halo reduction. Postoperatively, both patients had excellent restoration of spinal alignment as well as improvement in both pain and myelopathy. CONCLUSION: We achieved intraoperative reduction of occipitocervical instability through a purely posterior approach. This technique adds a tool to the armamentarium of techniques used for the treatment of occipitocervical instability.