Isolated parapharyngeal cold abscess in a 9-year-old boy

Area of Science:

• Pediatric Infectious Diseases
• Head and Neck Surgery
• Mycobacterial Infections

Background:

• Tuberculous adenitis commonly affects cervical lymph nodes.
• Parapharyngeal space abscesses are typically bacterial, not tuberculous.
• Isolated tuberculous parapharyngeal abscesses are exceedingly rare in children.

Observation:

• A 9-year-old boy presented with a 2-month history of progressive right neck swelling.
• Initial clinical diagnosis was neuroblastoma.
• Needle aspiration of the parapharyngeal space revealed cheesy material.

Findings:

• Mycobacterium tuberculosis was identified using DNA TB PCR.
• This confirmed tuberculous adenitis presenting as an isolated parapharyngeal cold abscess.
• This presentation is novel in the paediatric age group.

Implications:

• Tuberculosis must be considered in the differential diagnosis of paediatric cervical swellings.
• Early diagnosis and treatment of tuberculous adenitis are crucial.
• This case expands the known spectrum of tuberculous adenitis presentations in children.