A Rare Case of Neck Abscess Caused by Salmonella

Uncontrolled diabetes is a significant risk factor for infectious processes, many of which can present atypically. Salmonella frequently results in gastrointestinal infection, but direct inoculation or hematogenous spread can result in extraintestinal disease, a rare subset of which may include neck abscess. It is believed that patients with poorly controlled diabetes are predisposed to salmonellosis due to reduced gastric acidity and delayed gastric emptying, which promote survival and stagnation of the bacteria. This case demonstrates not only an otolaryngologic sequelae of uncontrolled diabetes, but the impact of care coordination and social determinants of health on medical outcomes for patients in rural and other underserved communities. We present the case of a 63-year-old man who arrived at the Emergency Department for medication reconciliation and was subsequently diagnosed with lymphadenitis. Conservative, stepwise management included oral antibiotics, ultrasound-guided aspiration and culture with broad-spectrum intravenous antibiotics, and ultimately incision and drainage. It is imperative in the diagnosis and management of individuals with atypical infections to consider predisposing conditions. In patients with hyperglycemia and neck abscess, Salmonella should be considered as a potential etiology. Additionally, timely, multidisciplinary care should be employed in order to coordinate medical management of comorbidities and improve compliance with preventative regimens while optimizing wound healing. Salmonellosis is a rare etiology of neck abscess that should be considered in patients with hyperglycemia. For those who do not respond to empiric regimens, culture sensitivity should direct definitive management.