A Rare Case of Parapharyngeal Abscess in a Healthy Adult: Importance of Timely Diagnosis and Intervention

Parapharyngeal abscesses are rare infections of the neck fascia, most common in young male children. These bacterial infections are difficult to treat due to the complex vasculature in the parapharyngeal spaces. Common complications of untreated abscesses include airway obstruction, internal jugular vein thrombosis, and septic shock. A 43-year-old male presented to the emergency department with a new onset of fever, dyspnea, and sore throat with odynophagia. A bacterial infection was suspected after a physical exam indicated swelling, erythema, and tenderness over the submandibular/parotid regions. Laboratory findings also indicated moderate leukocytosis of 18,000/µL. A subsequent clinical diagnosis of a parapharyngeal abscess was made post-contrast-enhanced computed tomography (CT) scan of the neck. Treatment was initiated with clindamycin, intravenous dexamethasone, and Toradol for analgesic relief. Otolaryngology consultation suggested a transoral incision and drainage (I/D) under general anesthesia. I/D was successful with 3 mL of Group A Streptococcus-laden purulent fluid aspirated. Post-procedure recovery was complication free with significant improvement in laboratory findings and symptoms. The patient's infection was resolved, and thus, further imaging was not required. A prophylactic seven-day course of oral Augmentin (amoxicillin-clavulanate) was prescribed at discharge. This case provides an excellent investigation into the importance of early intervention for rare bacterial infections of the head/neck region occurring in a patient population with no relevant risk factors.