Unusual presentation of retropharyngeal abscess complicated by vertebral osteomyelitis

Retropharyngeal abscesses are rare in adults and often associated with immunocompromised states or complications from foreign body ingestion. This case report highlights an unusual presentation of acute retropharyngeal abscess that subsequently led to cervical vertebral osteomyelitis and focal neurological deficit. We describe a middle-aged man who presented with a 10-day history of progressive dysphagia, right upper limb weakness and respiratory distress, culminating in stridor. Examination revealed a bulge in the posterior pharyngeal wall and motor weakness in the right upper limb (3/5 power). Imaging studies confirmed the diagnosis of retropharyngeal abscess with cervical vertebral osteomyelitis. The management involved surgical drainage of the abscess, antibiotic therapy and supportive care. In the absence of prior symptoms suggestive of a chronic vertebral infection, it was concluded that the osteomyelitis and monoparesis were secondary to the acute retropharyngeal abscess. This case underscores the importance of considering retropharyngeal abscess in adults presenting with progressive dysphagia and respiratory distress, particularly when associated with neurological deficits for prompt intervention. Diagnostic methods, management strategies and follow-up care are discussed to emphasise the complexities involved in such cases.