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[Chronic granulomatous disease accompanying a deep cervical abscess in a young child]
Insights
A rare cervical abscess in a child was successfully treated with surgery after ineffective antibiotics. Diagnosis of chronic granulomatous disease (CGD), an immunodeficiency, was challenging but confirmed via genetic testing.
Area of Science:
- Pediatric Otolaryngology
- Immunology
- Genetics
Background:
- Cervical abscesses can present with non-specific symptoms, complicating diagnosis in young children.
- Chronic Granulomatous Disease (CGD) is a primary immunodeficiency affecting phagocyte function, leading to recurrent infections.
- Otorhinological evaluation is crucial for managing complex head and neck infections.
Observation:
- A 19-month-old boy presented with fever and cervical abscess unresponsive to broad-spectrum antibiotics.
- Initial surgical drainage via paracentesis provided temporary relief, necessitating further intervention.
- Impaired active oxygen production was suspected due to treatment resistance, prompting further immunologic workup.
Findings:
- Surgical drainage and wound care with oxydol led to successful resolution of the cervical abscess.
- Diagnostic challenges in identifying CGD were overcome through flow cytometry confirming deficient cytochrome b production.
- Autosomal recessive inheritance pattern was established, with both parents identified as carriers.
Implications:
- This case highlights the importance of considering underlying immunodeficiencies in recurrent or treatment-refractory pediatric infections.
- Early and accurate diagnosis of CGD is critical for appropriate management and genetic counseling.
- Multidisciplinary collaboration between pediatrics, otorhinolaryngology, and immunology is essential for optimal patient outcomes.
Abstract:
We report the diagnosis and otorhinological treatment of a rare case of cervical abscess in association with chronic granulomatous disease (CGD). A 19-month-old boy was admitted to our hospital's Department of Pediatrics with fever and a swollen neck. Antibiotic treatment (FMOX PIPC, and PAPM) was ineffective, so the patient was referred to our department for otorhinological treatment. A deep cervical abscess was drained using paracentesis in the Outpatient Department, but the condition did not improve. Surgery to drain the cavity was therefore performed. The wound was irrigated with oxydol, and the surgery was a success. Immunodeficiency was suspected, because of the antibiotic treatment's failure. Further examination clarified that the disease was CGD, but this diagnosis was difficult to establish. The result of the NBT test was 120%. However, some examination demonstrated that active oxygen production was impaired. The production of cytochrome b in this patient was confirmed using flow cytometric analysis. Both parents were confirmed to be carriers upon examination. The patient was therefore diagnosed as having CGD as a result of an autosomal recessive inheritance.