Author(s)
D. C. Menapace
S. C. Wise
T. G. Boyce
L. J. Orvidas
Affiliation(s)
Mayo School Of Graduate Medical Education; Mayo Clinic
Abstract:
We present a case of a unusual retropharyngeal abscess caused by Mycobacterium avium-intracellulare and review the literature. A healthy 2-year-old girl presented to a community otolaryngology practice with obstructive sleep apnea (OSA) and nasal obstruction. She was taken to the operating room for planned adenoidectomy. A large, retropharyngeal mass was discovered, and the operation was aborted. She was referred to our institution for further management. Computed tomography of the head and neck demonstrated a five-centimeter retropharyngeal mass. CT-guided biopsy revealed necrotic, granulomatous debris consistent with an abscess. Subsequent cultures grew Mycobacterium avium-intracellulare. Operative management was deferred due to its potential morbidity. The patient received culture-directed antimicrobial therapy with azithromycin, ethambutol, and rifampin. Clinical examination and magnetic resonance (MR) imaging were used to assess response to therapy at close intervals. After nine months, antimicrobial therapy was discontinued. At six months following conclusion of antibiotic therapy, endoscopy and interval MR imaging demonstrated resolution of the abscess. Mycobacterium avium-intracellulare infections involving the retropharyngeal space are rare in immunocompetent children. Typically they occur in the anterior and posterior cervical and supraclavicular regions. The clinical presentation of retropharyngeal abscesses is most commonly acute in onset with symptoms including fever, airway compromise, dysphagia, and neck stiffness. However, it may present in a more insidious manner with chronic symptoms such as nasal obstruction and OSA. Certain cases may be amenable to non-operative management with culture-directed antimicrobial therapy.