A rare case of tuberculous abscess causing airway obstruction in a paediatric patient in South-East Asia

Document Type : Case report

Authors

1 Department of Otorhinolaryngology- Head & Neck Surgery, National University of Malaysia Medical Centre, Kuala Lumpur

2 Ear, Nose, Throat-Head & Neck Consultant Clinic, KPJ Seremban Specialist Hospital/KPJ Healthcare University College, Negeri Sembilan

3 Department of Otorhinolaryngology-Head & Neck Surgery, Serdang Hospital, Serdang, Selangor, Malaysia

4 Department of Otorhinolaryngology, Head and Neck Surgery Faculty of Medicine University Kebangsaan Malaysia Medical Centre Kuala Lumpur Malaysia

Abstract

A 6-year old girl, presented with symptoms of obstructive sleep apnoea. She was referred to our centre when she developed obstructive symptoms such as stridor and dysphagia a month later. She was found to have a right neck swelling with a posterior pharyngeal wall mass, which caused upper airway obstruction. A computerized-tomography scan of her neck showed a very narrowed upper airway with a retropharyngeal abscess without prevertebral or vertebral involvement. She had a challenging intubation and underwent an emergency intraoral incision and drainage. Pus that was drained revealed acid fast bacilli and histopathological examination showed necrotizing granulomatous inflammation, in favour of a tuberculous abscess. Post operatively, her symptoms resolved and her intraoral wound healed. She completed anti-tuberculous treatment and has remained well at 6 months follow up. Our case illustrates how a cold retropharyngeal abscess can masquerade as obstructive sleep apnoea, with a compromised airway as it increases in size.

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