Vol 39 # 2 June 2007 - Kma.org.kw

June 2007KUWAIT MEDICAL JOURNALABSTRACTCase ReportRetropharyngeal Candidal Abscess in a Neonate: CaseReport and Review of LiteratureSontenam V S Mallik A Rao, Muneera Al Adwani, Chandramouli BharatiDepartment of Radiology, Al Jahra Hospital, KuwaitKuwait Medical Journal 2007, 39 (2):177-180Retropharyngal abscess (RPA) in a newborn baby is veryr a re. It is usually caused by group B hemolyticstreptococci and other aerobic or anerobic bacteria. Theabscess may cause compression of airway and breathingdifficulties with resultant life - threatening complications.We report here a rare case of RPA caused by Candidaalbicans in a newborn, who presented with cyanosis to theNeonatal Intensive Care Unit (NICU) in Jahra Hospitaland was treated successfully after thorough investigations.To the best of our knowledge this is the first such casereport, considering the causative organism, cyanosis andage of the baby.KEY WORDS: Candida albicans, neonate, retropharyngeal abscessINTRODUCTIONRetropharyngal abscess (RPA) is a potentiallyserious deep space neck infection. RPA can be ofmedical or traumatic origin. Non-traumatic RPA islargely a disease of younger children, as a result ofdevelopmental aspects of the neck lymphaticsystem [1-3] . Among children it is very rare in thenewborn. The abscess occurs either by lymphatic orhematogenous spread from oral or upperrespiratory tract infections. Also transmission ofinfection from maternal circulation or the genitaltract is known. A e robes, anerobes and gramnegative organisms were involved as causativeorganisms, more commonly the Staphylococci andg roup B hemolytic S t re p t o c o c c i [ 2 , 3 ] . Review ofliterature revealed that RPA due to Candida albicansin early neonatal period has not been reported.CASE REPORTA newborn female baby weighing 3.5 kg wasdelivered by normal spontaneous vaginal deliverywith an Apgar score of 8/9. At one hour afterdelivery she developed two cyanotic attacks withstridor (without feeding) and the baby was shiftedto the NICU by the neonatologist with a provisionaldiagnosis of congenital laryngomalacia. In the next48 hours the stridor was controlled and mildhypocalcemia was corrected. At the end of the 1stweek, it was found that the child was developingcyanosis and stridor in supine position and wasbetter and more comfortable in prone positionwithout cyanosis or stridor. Also, extensive oralmucosal candidiasis was noted.While searching for the causes of laryngealobstruction and doubtful swelling in the neck, theENT surgeon had asked for an X-ray of the necklateral view. It showed widened prevertebral spacewith smooth indentation over posterior pharyngealwall (Fig. 1). Ultrasound (US) scanning revealed an o n - c o m p ressible cyst like lesion with possibleentrapped air pockets in the re t ro and leftparapharyngeal region (Fig. 2). No change in size ofthe lesion was observed when the child cried. Sincethe lesion was inconclusive on US, CT scan neckwas suggested. This showed a 37x 28x 20 mm sized( a p p roximate), well marginated lesion withenhancing thick wall and internal air fluid levels inthe re t ropharyngeal and left parapharyngealspaces (Figs. 3 and 4). Pharyngolarynx, carotidsheath and esophagus were compressed anddisplaced. No communication with airway oresophagus could be appreciated. A CT diagnosis ofa RPA was made.As the diagnosis of abscess in the newbornwithout obvious risk factors is unconvincing, theneonatologists insisted on a MRI scan to excludecongenital lesions. The MRI neck also showedsimilar findings as the CT scan i.e., retro and leftparapharyngeal lesion with thick enhancing walland air fluid levels in the lesion causingcompression of the airway (Figs. 5, 6 and 7). Nocommunication with pharyngolarynx or esophagusAddress correspondence to:Dr.Sontenam V.S.Mallik, MD,DNB, FRCR (London), Radiologist, Department of Radiology, Al Jahra Hospital, P.O.Box.1807, Jahra 01020,Kuwait. Tel/Fax: (965) 4577198, E-mail:svsmrao@yahoo.co.in