A case of cervical Pott's disease revealed by parapharyngeal abscess.

INTRODUCTION

We report a case of cervical Pott's disease revealed by parapharyngeal abscess.

CASE REPORT

A seven-year-old boy was admitted with a three-week history of painful fluctuating left lateral cervical swelling, associated with night sweats. Examination found trismus, through which a lateral pharyngeal bulge could be observed. Incision and drainage of the abscess on a combined cervical-oropharyngeal approach was performed under general anesthesia, associated to non-specific antibiotherapy by parenteral route. Bacteriology was negative. After one week of antibiotherapy, fever persisted with onset of torticollis. A diagnosis of tuberculosis was considered. Tuberculin skin test was positive at 16.5 mm. A second sample by pharyngeal aspiration showed caseous pus with acid-fast bacilli. Cervical spine CT found a retrostyloid abscess with atlantoaxial lysis. Cervical Pott's disease complicated by Grisel syndrome was diagnosed. Antituberculosis therapy was initiated. Results at five months' follow-up were satisfactory.

DISCUSSION/CONCLUSION: Parapharyngeal abscess with an etiology of Pott's disease is rare. Modern imaging is highly contributive to diagnosis and follow-up of lesion regression under treatment.