Retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case study

Abstract Background Cystic fibrosis (CF) is a chronic, genetic, incurable disease that affects primarily the respiratory and gastrointestinal systems. End-stage lung disease is the leading cause of death in people with CF, and lung transplant is required to preserve life. Anti-rejection medications...

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Main Authors: Sigrid Ladores, Leigh Ann Bray, Janet Brown, Jessica Corcoran, Jeremy Jordan, Erin Buczek
Format: Article
Language:English
Published: BMC 2020-08-01
Series:BMC Pulmonary Medicine
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12890-020-01269-6
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spelling doaj-92d5fdccfb0640078d38f549be957d8e2020-11-25T03:49:15ZengBMCBMC Pulmonary Medicine1471-24662020-08-012011510.1186/s12890-020-01269-6Retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case studySigrid Ladores0Leigh Ann Bray1Janet Brown2Jessica Corcoran3Jeremy Jordan4Erin Buczek5University of Alabama at Birmingham School of NursingUniversity of Alabama at Birmingham School of NursingUniversity of Alabama at Birmingham School of NursingUniversity of Alabama at Birmingham School of NursingUniversity of Alabama at Birmingham School of NursingUniversity of Alabama at Birmingham School of MedicineAbstract Background Cystic fibrosis (CF) is a chronic, genetic, incurable disease that affects primarily the respiratory and gastrointestinal systems. End-stage lung disease is the leading cause of death in people with CF, and lung transplant is required to preserve life. Anti-rejection medications are necessary post-transplant; however, these medications lower immune response and increase susceptibility to bacterial infections. Complications from infections post lung-transplant account for approximately 30% of CF-related deaths. Retropharyngeal abscess (RPA) is a rare deep neck infection that occurs most commonly in children. This is the case of a 45-year-old Caucasian male with CF who developed a retropharyngeal abscess post wisdom teeth extraction that seeded into hardware from a previous cervical disc fusion. Case presentation The patient presented to the emergency department with severe neck and shoulder pain, limited range of motion in his arm and neck, and dysphonia. He reported feeling pain for 10 days and suspected the pain was caused by a weightlifting injury. The patient reported low-grade fever 5 days prior, which responded to acetaminophen. He was afebrile upon admission and in no respiratory distress. Diagnostic labs revealed WBC 22,000/uL and CRP 211 mg/L. The CT scan showed a large abscess in the retropharyngeal space between C2-C7. The immediate concern was airway obstruction and need for possible intubation or tracheostomy. The patient was transferred to ENT service with neurosurgery and transplant consults. The RPA was drained and lavaged. The cervical hardware was discovered to be infected and was removed. The source of the RPA infection was determined to be from the patient’s wisdom teeth extraction 6 months prior to RPA. The patient received 8 weeks of intravenous ceftriaxone for Streptococcus pneumoniae bacteremia and underwent revision of his cervical fusion 3 months after hardware removal. Conclusions Clinicians should consider prophylactic antimicrobial therapy for immunocompromised patients when they are at increased risk for transient bacteremia such as following invasive procedures (e.g., tooth extraction). Prophylactic antimicrobial therapy could prevent potentially life-threatening infections such as RPA in immunocompromised patients.http://link.springer.com/article/10.1186/s12890-020-01269-6Cystic fibrosisPost lung-transplant complicationsRetropharyngeal abscessCase reportDental surgery
collection DOAJ
language English
format Article
sources DOAJ
author Sigrid Ladores
Leigh Ann Bray
Janet Brown
Jessica Corcoran
Jeremy Jordan
Erin Buczek
spellingShingle Sigrid Ladores
Leigh Ann Bray
Janet Brown
Jessica Corcoran
Jeremy Jordan
Erin Buczek
Retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case study
BMC Pulmonary Medicine
Cystic fibrosis
Post lung-transplant complications
Retropharyngeal abscess
Case report
Dental surgery
author_facet Sigrid Ladores
Leigh Ann Bray
Janet Brown
Jessica Corcoran
Jeremy Jordan
Erin Buczek
author_sort Sigrid Ladores
title Retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case study
title_short Retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case study
title_full Retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case study
title_fullStr Retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case study
title_full_unstemmed Retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case study
title_sort retropharyngeal abscess in a post-lung transplant cystic fibrosis patient with prior cervical fusion: a case study
publisher BMC
series BMC Pulmonary Medicine
issn 1471-2466
publishDate 2020-08-01
description Abstract Background Cystic fibrosis (CF) is a chronic, genetic, incurable disease that affects primarily the respiratory and gastrointestinal systems. End-stage lung disease is the leading cause of death in people with CF, and lung transplant is required to preserve life. Anti-rejection medications are necessary post-transplant; however, these medications lower immune response and increase susceptibility to bacterial infections. Complications from infections post lung-transplant account for approximately 30% of CF-related deaths. Retropharyngeal abscess (RPA) is a rare deep neck infection that occurs most commonly in children. This is the case of a 45-year-old Caucasian male with CF who developed a retropharyngeal abscess post wisdom teeth extraction that seeded into hardware from a previous cervical disc fusion. Case presentation The patient presented to the emergency department with severe neck and shoulder pain, limited range of motion in his arm and neck, and dysphonia. He reported feeling pain for 10 days and suspected the pain was caused by a weightlifting injury. The patient reported low-grade fever 5 days prior, which responded to acetaminophen. He was afebrile upon admission and in no respiratory distress. Diagnostic labs revealed WBC 22,000/uL and CRP 211 mg/L. The CT scan showed a large abscess in the retropharyngeal space between C2-C7. The immediate concern was airway obstruction and need for possible intubation or tracheostomy. The patient was transferred to ENT service with neurosurgery and transplant consults. The RPA was drained and lavaged. The cervical hardware was discovered to be infected and was removed. The source of the RPA infection was determined to be from the patient’s wisdom teeth extraction 6 months prior to RPA. The patient received 8 weeks of intravenous ceftriaxone for Streptococcus pneumoniae bacteremia and underwent revision of his cervical fusion 3 months after hardware removal. Conclusions Clinicians should consider prophylactic antimicrobial therapy for immunocompromised patients when they are at increased risk for transient bacteremia such as following invasive procedures (e.g., tooth extraction). Prophylactic antimicrobial therapy could prevent potentially life-threatening infections such as RPA in immunocompromised patients.
topic Cystic fibrosis
Post lung-transplant complications
Retropharyngeal abscess
Case report
Dental surgery
url http://link.springer.com/article/10.1186/s12890-020-01269-6
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