Concurrent Intratonsillar, Peritonsillar, and Retropharyngeal Abscesses: Case Report of Multiple Deep Neck Space Infection
DOI:
https://doi.org/10.59141/-.v8i1.506Keywords:
Deep neck infection, intratonsillar, peritonsillar, retropharyngeal, abscessAbstract
Deep neck space infections are potentially life-threatening conditions due to their proximity to vital structures such as the airway, major blood vessels, and cranial nerves. These infections may spread rapidly and lead to severe complications, including airway obstruction and sepsis. This study aims to describe a rare case of concurrent intratonsillar, peritonsillar, and retropharyngeal abscesses, as well as to evaluate the effectiveness of conservative management using intravenous antibiotics. This research employed a descriptive qualitative case report approach involving a 32-year-old male patient presenting with progressive throat pain, dysphagia, neck swelling, and a muffled voice. Data were collected through clinical examination, laboratory tests, and radiological imaging, followed by continuous observation during hospitalization. The findings revealed elevated leukocyte levels and radiographic evidence of retropharyngeal space widening. The patient was treated with intravenous cefotaxime and metronidazole, along with supportive therapy. Significant clinical improvement was observed within 48 hours, with resolution of symptoms by the fifth day without surgical intervention. In conclusion, early diagnosis and prompt antibiotic therapy can effectively manage selected cases of multiple deep neck abscesses. Conservative treatment may be considered in stable patients, potentially avoiding invasive procedures while ensuring favorable clinical outcomesDownloads
References
1. Esposito, S., De Guido, C., Pappalardo, M., Laudisio, S., Meccariello, G., Capoferri, G., Rahman, S., Vicini, C., & Principi, N. (2022). Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses. Children (Basel, Switzerland), 9(5), 618. https://doi.org/10.3390/children9050618
2. Mohamed, D., McDowell, R. H., Winters, R., & Hyser, M. J. (2025). Neck Abscess. In StatPearls. StatPearls Publishing.
3. Rijal, S., & Romdhoni, A. C. (2018). Bacteria Pattern, Results of Antibiotic Sensitivity Test, and Complications of Deep Neck Abscess Patients in Dr. Soetomo General Hospital. Biomolecular and Health Science Journal, 1(2), 124–130. https://doi.org/10.20473/bhsj.v1i2.9832
4. Almuqamam M, Gonzalez FJ, Sharma S, et al. Deep Neck Infections. [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513262/
5. Krishnaprasadh D, Hohman MH, McDowell RH. Peritonsillar Abscess. [Updated 2026 Jan 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519520/
6. Nimmana BK, Paterek E. Tonsillitis. [Updated 2025 Jul 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544342/
7. Corbin, A. F., Vijay, A., Fried, J., & Carr, M. M. (2024). Acute Intratonsillar Abscess in an Adult: A Case Report and Literature Review. Cureus, 16(1), e51657. https://doi.org/10.7759/cureus.51657
8. Singh, G. B., Kumar, D., Arora, R., Garg, S., & Ranjan, S. (2015). A Rare Case of Intratonsillar Abscess in an Adult. Clinics and practice, 5(4), 804. https://doi.org/10.4081/cp.2015.804
9. Castagnini, L. A., Goyal, M., & Ongkasuwan, J. (2015). Tonsillitis and Peritonsillar Abscess. Infectious Diseases in Pediatric Otolaryngology: A Practical Guide, 137–150. https://doi.org/10.1007/978-3-319-21744-4_10
10. Hirvonen, J., Lingam, R.K. & Connor, S. ESR Essentials: acute infections of the head and neck—practice recommendations by the European Society of Head and Neck Radiology. Eur Radiol 36, 334–343 (2026). https://doi.org/10.1007/s00330-025-11818-4
11. Hendrayani, A. A. A. S. V., & Nalle, T. S. (2025). The management of retropharyngeal abscess in adult patient. Oto Rhino Laryngologica Indonesiana, 55(1), 67–74. https://doi.org/10.32637/orli.v55i1.689
12. Jain H, Hohman MH, Sinha V. Retropharyngeal Abscess. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441873/
13. Loperfido A, Stasolla A, Giorgione C, et al. (February 14, 2023) Management of Deep Neck Space Infections: A Large Tertiary Center Experience. Cureus 15(2): e34974. doi:10.7759/cureus.34974
14. Kim, Y. J., Kim, J. D., Ryu, H. I., Cho, Y. H., Kong, J. H., Ohe, J. Y., Kwon, Y. D., Choi, B. J., & Kim, G. T. (2011). Application of radiographic images in diagnosis and treatment of deep neck infections with necrotizing fasciitis: a case report. Imaging science in dentistry, 41(4), 189–193. https://doi.org/10.5624/isd.2011.41.4.189
15. Reyes, M. M., Ricalde, R. R., Tanalgo, J. B., & Baldoz, C. J. (2011). Prevertebral soft tissue thickness among pediatric patients. Philippine Journal of Otolaryngology–Head and Neck Surgery, 26(2), 5–9. https://doi.org/10.32412/pjohns.v26i2.565
16. Tsai, Y. W., Liu, Y. H., & Su, H. H. (2018). Bacteriology of peritonsillar abscess: the changing trend and predisposing factors. Brazilian journal of otorhinolaryngology, 84(5), 532–539. https://doi.org/10.1016/j.bjorl.2017.06.007
17. Arianto, D. R., & Romdhoni, A. C. (2019). Pola kuman, hasil uji sensitifitas antibiotik dan komplikasi abses leher dalam di RSUD DR. Soetomo. Jurnal Ilmiah Kedokteran Wijaya Kusuma, 8(1), 88–98. https://doi.org/10.30742/jikw.v8i1.557
18. Hartedja, K. K., Yue, R., & Moehario, L. H. (2021). Microbe pattern and risk factors of deep neck abscess patients in Atma Jaya Hospital. Damianus Journal of Medicine, 20(1), 26–32. https://doi.org/10.25170/djm.v20i1.1734
19. Prasetyo, H., & Surjotomo, H. (2024). Karakteristik penderita abses leher dalam pada bagian THT-KL RSUD Dr. Saiful Anwar Malang periode 1 Januari 2020 – 31 Desember 2021. Malang Otorhinolaryngology Head and Neck Surgery Journal, 3(2). https://moj.ub.ac.id/index.php/moj/article/view/52
20. Repanos C, Mukherjee P, Alwahab Y. Role of microbiological studies in management of peritonsillar abscess. The Journal of Laryngology & Otology. 2009;123(8):877-879. doi:10.1017/S0022215108004106
21. Cho, S. Y., Woo, J. H., Kim, Y. J., Chun, E. H., Han, J. I., Kim, D. Y., Baik, H. J., & Chung, R. K. (2016). Airway management in patients with deep neck infections: A retrospective analysis. Medicine, 95(27), e4125. https://doi.org/10.1097/MD.0000000000004125
22. Alwagdani, A. M., Alwabel, S. K., Alyami, B. H., Rajkhan, A. A., Alshehri, A. A., Aloufi, M. S., Alandijani, H. A., Alsaeedi, B. R., Alshaikh, R. M., Aldhammen, A. A., & Alnemer, R. A. (2021). Medical and surgical outcome of retropharyngeal abscess and its prognosis. International Journal Of Community Medicine And Public Health, 8(10), 5137–5141. https://doi.org/10.18203/2394-6040.ijcmph20213825
23. Al Riyami, S. (2025). Presentation and characteristics of deep neck space abscesses: a retrospective study of 128 cases in a single institution. International Journal of Otorhinolaryngology and Head and Neck Surgery, 11(5), 513–518. https://doi.org/10.18203/issn.2454-5929.ijohns20252824
24. Khudan, A., Jugmohansingh, G., Islam, S., Medford, S., & Naraynsingh, V. (2016). The effectiveness of conservative management for retropharyngeal abscesses greater than 2 cm. Annals of Medicine and Surgery, 11, 62–65. https://doi.org/10.1016/j.amsu.2016.10.001
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