Chronic retropharyngeal abscess presenting as obstructive sleep apnea

Area of Science:

• Pediatric Otolaryngology
• Pediatric Pulmonology
• Pediatric Infectious Diseases

Background:

• Chronic retropharyngeal abscess (RPA) is an uncommon pediatric condition.
• Obstructive sleep apnea (OSA) in children has various known causes, but RPA as an etiology is not previously reported.
• Severe OSA in infants necessitates a thorough differential diagnosis.

Observation:

• An infant presented with severe obstructive sleep apnea (OSA).
• Oropharyngeal narrowing due to a chronic abscess was identified as the cause of OSA.
• Intraoperative MRI confirmed the retropharyngeal abscess (RPA).

Findings:

• Successful treatment involved tracheostomy, surgical abscess drainage, and a course of intravenous and oral antibiotics.
• The infant's severe OSA resolved following treatment of the RPA.
• This case highlights a novel presentation of RPA in pediatric OSA.

Implications:

• Physicians should consider suppurative oropharyngeal pathology, such as RPA, in children with new-onset severe OSA, especially after a respiratory infection.
• A history of head or neck abscess drainage should increase suspicion for RPA.
• Early recognition and management of RPA can prevent serious complications associated with severe OSA.