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

178Retropharyngeal Candidal Abscess in a Neonate: Case Report and Review of Literature June 2007Fig. 1: Lateral X-ray neck showing widened pre-vertebral space andsmooth posterior indentation over airwayFig. 2: 2D B-mode Ultrasound showing cystic lesion with echogenicdebris and thick wall causing displacement of carotid sheath contentsFig. 3: Plain CT scan neck showing fluid attenuating lesion in retro andleft parapharyngeal space causing elevation and compression of airwaywas noted. Hemogram showed leucocytosis withn e u t rophilia, lymphocytosis, eosinphilia. (WBC16.7 x 10 9 / l, NE 49%, LY 36%, MO 6%, EO 9%) andnormal RBC and platelet count. Diagnostic andtherapeutic US guided percutaneous needleaspiration yielded approximately 15 ml of lightgreenish yellow pus which showed a cell count ofRBC 3840 cells/mm 3 , WBC 181,760 cells/mm 3 with97% neutrophils and 3% lymphocytes. Culture ofthis pus yielded the growth of Candida specieswhich on yeast culture was identified as Candidaalbicans, sensitive to amphotericin B, fluconazoleand 5 - flucytosine. Further blood test detectedcandidal antigen 1:2 by latex agglutination test.Treatment was then started with ambisone, 3 mgonce a day as infusion over two hours andi n c reasing daily by 1 mg for ten days with total dosenot exceeding 50 mg. Also, antibiotics were givenFig. 4: Contrast enhanced CT scan neck showing moderate enhancementof the lesion wall with air-fluid levelss i m u l t a n e o u s l y. With this clinical course andmanagement the baby improved within two weekswith no cyanotic spells or stridor. During thecourse, CT and US scans were repeated to see theradiological improvement. Resolving air fluidlevels with collapsed abscess and opened upairway was noted after ten days (Fig. 8). Furtherfollow up was advised with the pediatric and ENTsurgeon and the child was discharged.DISCUSSIONA deep space neck infection, RPA is a seriousand occasionally life-threatening condition due toits anatomic location and the potential to obstructthe upper airway [3] . The presentation of RPA issometimes subtle, and the constellation of findingsis apparently variable. However, eighty-fivep e rcent of newborns with early-onset infectionpresent within 24 hours [4,6] . Common presenting