[Case report of tuberculous retropharyngeal abscess]

We report a case of tuberculous retropharyngeal abscess. The case reported was an 89 year old female. She visited our hospital with a complaint of swelling in the neck, a feeling of choking and a feeling of dysphagia. With a test puncture to the neck tumor, acid-fast stained bacilli were detected from punctured pus and the patient was hospitalized immediately due to a suspicion of tuberculous retropharyngeal abscess. As present illnesses, mucosal retraction and protrusion were found in the area from the right pharyngeal back to the oral cavity. Palpation revealed soft tumors of a ping-pong ball size without tenderness nor febrile sensation in the right submandibular region and left supraclavicular fossa in the neck. In the cervical contrast enhanced CT images, an abscess was found in the hypopharyngeal posterior gap and was shown as LDA (low density area) surrounded by strongly contrasting walls. The tumor was divided horizontally at the second cervical vertebra and shown strongly at the left cervical region as it goes downward, and in the region from the 6th cervical vertebra to the second thoracic vertebra, vertebral body destruction and numerous small abscesses in the vertebral anterior gap were found. Chest images revealed infiltration (r III 2) in the right lung, but the sputum smear was negative (-) for tubercle bacilli. As the abscess punctured fluid was TB-PCR (+), she was diagnosed as tuberculous retropharyngeal abscess, and a treatment was started with HRS (combination of isoniazid, rifampicin and streptomycin). Due to elevated feeling of suffocation and feeling of dysphagia during hospitalization, CT-guided cervical abscess puncture (using a 21G puncture needle) was performed twice to drain 100 ml and 80 ml pus. Subsequently, since the symptoms have improved and retention of abscesses was not found, the patient was discharged from the hospital. After the treatment for 9 months, no recurrence was reported.