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Tongue protrusion as the presenting symptom of parapharyngeal abscess
Timothy Visclosky1, Sarah Tomlinson1, Lauren Bohm2
1Department of Emergency Medicine University of Michigan Ann Arbor Michigan USA.
Insights
Diagnosing deep neck space infections in children, especially those with comorbidities like Trisomy 21, is challenging. A parapharyngeal abscess can present atypically, mimicking other conditions, requiring high clinical suspicion for prompt pediatric care.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Genetics
Background:
- Deep neck space infections are common in children but difficult to diagnose.
- Pediatric patients present with non-specific symptoms, compounded by developmental factors.
- Comorbidities can mask severe systemic symptoms, complicating diagnosis.
Observation:
- A 2-year-old female with Trisomy 21 presented with apparent tongue swelling.
- Initial treatment for presumed angioedema due to ACE inhibitors was unsuccessful.
- The patient was ultimately diagnosed with a parapharyngeal abscess.
Findings:
- The parapharyngeal abscess caused mass effect, leading to tongue protrusion.
- This case illustrates a novel early presentation of a common pediatric infection.
- Diagnostic challenges in deep neck space infections in children are highlighted.
Implications:
- Emphasizes the need for high suspicion in diagnosing deep neck space infections in pediatric patients.
- Highlights the importance of considering atypical presentations in children with Trisomy 21.
- Underscores the diagnostic difficulties posed by comorbidities in pediatric infections.
Abstract:
Deep neck space infections are commonly seen in the pediatric population. The diagnosis, however, can be challenging to make and requires a high degree of suspicion because of developmental and age-related factors in children and non-specific presenting symptoms. Diagnosis becomes further complicated in patients whose comorbid conditions mask some of the more severe systemic symptoms. We present a case of a 2-year-old female with Trisomy 21 who presented with a chief concern of "tongue swelling" per parents. After initially failing treatment for presumed angioedema caused by an angiotensin-converting enzyme inhibitor, she was ultimately diagnosed with a parapharyngeal abscess with extension and mass effect causing tongue protrusion. This case represents a novel early presentation of a common infection and highlights the challenges of diagnosing deep neck space infections in children.
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