Dados do Trabalho

Título

Successful approach: a case report of a periamygdental abscess with spinal cord compression.

RESUMO

L.R.N.O., a 60-year-old male, hypertensive and decompensated diabetic, was admitted in July 2021 to the emergency department with ataxia, erythematous patches in upper and lower limbs, edema in large joints associated with odynophagia, and fever. The patient was referred to the hospital unit for cardiology and rheumatology support, and purulent collections were identified on the topography of the right shoulder and left elbow. Cervical tomography showed retropharyngeal collection extending posteriorly to the left paravertebral space. An etiologic investigation and antibiotic therapy were initiated. In September, the patient developed acute tetraparesis and intense cervicalgia and was referred to the neurosurgery department, where neck MRI showed maintenance of the images, with invasion into the vertebral canal and compression of the anterior aspect of the spinal cord from C1 to C3, causing signs of myelopathy. He underwent laminectomy of C1 and drainage of epidural empyema in that service. After changing antibiotic treatment in which he was admitted to Vancomycin and Cefepime he progressed to the improvement of strength in all 4 limbs, cervicalgia, and headache. Despite cultures collected, the infectious agent was not identified.

Deep neck space infections are suppurative infectious processes that can cause abscesses and affect deep visceral spaces of the neck such as the parapharyngeal space and the danger space. A common etiology is the spread of oropharyngeal infections, such as odontogenic infections and tonsillitis, through fascial planes. Deep cervical infections can be fatal due to jugular vein thrombosis, airway obstruction, mediastinitis, and sepsis. This paper aims to report a successful case of a periamygdala abscess with deep cervical dissemination, resulting in tetraparesis and a dismal prognosis.

The evolution of antibiotic therapy was responsible for a decrease in the incidence of deep cervical space abscesses. However, in the last decade, the number of this type of abscesses has increased. The patient follows this trend and reveals systemic comorbidities of diabetes mellitus without disease control. Therefore, although tonsillitis is a common infection, it can generate important and fatal complications. In this paper we present a case report with significant neurological involvement, such as epidural empyema, with severe headache, tetraparesis, and cervicalgia, giving a dismal prognosis. However, the patient had a positive prognosis.

Palavras Chave

spinal cord compression; periamygdental abscess; tetraparesis