Otorhinolaryngology, Pedro Hispano Hospital, Porto, Matosinhos, Portugal
Otorhinolaryngology, Pedro Hispano Hospital, Porto, Matosinhos, Portugal.
BMJ Case Rep. 2020 Dec 18;13(12):e236415. doi: 10.1136/bcr-2020-236415.
A 38-year-old woman with Crohn's disease, under immunosuppressive therapy, was referred to the emergency department for severe progressive neck pain and fever, with 1 week of evolution. She was unable to perform neck mobilisation due to the intense pain aroused. She referred dysphagia. Oral cavity, oropharynx, hypopharynx and larynx showed no alterations. She had an increased C reactive protein. Central nervous system infections were excluded by lumbar puncture. CT was normal. Only MRI showed T2 hyperintensity of the retropharyngeal and prevertebral soft tissues of the neck without signs of abscess. The patient was treated with broad spectrum antibiotics. Complications of deep neck infection include abscess formation, venous thrombosis and mediastinitis. In this case, no complications occurred. A high degree of clinical suspicion is essential as deep neck infections need to be promptly diagnosed and treated given their rapidly progressive character, especially in immunocompromised patients.
一位 38 岁女性，患有克罗恩病，正在接受免疫抑制治疗，因严重进行性颈痛和发热，伴 1 周病程，被转至急诊。由于强烈的疼痛，她无法进行颈部活动。她诉吞咽困难。口腔、口咽、下咽和喉部未见异常。C 反应蛋白升高。腰椎穿刺排除中枢神经系统感染。CT 正常。只有 MRI 显示颈部咽后和椎前软组织的 T2 高信号，无脓肿迹象。患者接受了广谱抗生素治疗。深部颈感染的并发症包括脓肿形成、静脉血栓形成和纵隔炎。在本例中，未发生并发症。深部颈感染需要迅速诊断和治疗，因为其具有快速进展的特点，尤其是在免疫功能低下的患者中，因此高度的临床怀疑至关重要。
