Presentation
Presented with an enlarging soft tissue mass overlying the left neck and fevers. Found to have bacteremia.
Patient Data
A large heterogeneous fluid collection within the left neck is centered about the sternocleidomastoid muscle and is present along the inferior aspect of the parotid space abutting the masseter with extension through the stylomandibular tunnel contacting the inferior margin of the medial pterygoid muscle with mass effect upon the parapharyngeal space.
There is extension into the left submandibular space with anterior displacement of the left submandibular gland with a contact along the left pharyngeal mucosal space and hypopharynx/supraglottic laryngeal structures.
There is extension along the carotid space with several sites of peripheral enhancement appearing consistent with further abscesses. There is associated medial deviation of the left common carotid artery, carotid bifurcation, carotid bulb, and proximal branches of the external carotid artery. There is no appreciable arterial narrowing.
The left internal jugular vein is not visualized below the skull base and is presumably thrombosed and/or compressed.
Case Discussion
This is a case of a left-sided neck abscess secondary to Klebsiella pneumoniae, likely secondary to untreated newly diagnosed diabetes mellitus with blood glucose levels continually >400. According to the patient, the infection started as a small pustule on his neck.
The patient underwent a total of three incision and drainage procedures releasing purulent fluid. Abscess culture and smear revealed 2+ polymorphonuclear cells with culture positive for 1+ Klebsiella pneumonia complex. Similarly, the tissue culture and smear displayed 4+ polymorphonuclear cells, 1+ gram positive cocci with culture positive for 1+ Klebsiella pneumoniae complex. Blood cultures were positive for Klebsiella pneumoniae.
Gross pathologic examination revealed tan-white to brown necrotic-appearing soft tissue. When serially sectioned, the tissue revealed variegated, tan-yellow tissue and friable cut surface. Histopathology displayed fibroadipose and connective tissue with acute and chronic inflammation consistent with an abscess. Gram and Grocott methenamine silver special stains were negative for bacterial and fungal organisms respectively.
The patient did well postoperatively with no active drainage on follow-up with otolaryngology.
Co-author:
Trevina Soliman
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