A retropharyngeal abscess presenting with acute torticollis

Retropharyngeal abscess is a potentially life-threatening infection involving the retropharyngeal space which requires prompt diagnosis and aggressive therapy; it develops after acute infections of the upper airways that induce inflammation of the retropharyngeal lymph nodes. We present a case of an 8-year-old girl with acute torticollis, otalgia in the left ear and fever not responding to antibiotic therapy. The initial diagnosis was mastoiditis, but the persisting of symptomatology required magnetic resonance imaging of the neck, that showed a mass suggesting a retropharyngeal abscess extending to the jugular-carotid space, and endoscopic examination of the upper airways, that revealed a bulking in the left parapharyngeal space. The patient underwent surgery through a transoral approach to avoid involvement of the mediastinum or of the cervical spine. The association between retropharyngeal abscess and torticollis, especially as a presenting symptom, is rare and has been seldom reported in the literature. In this case, torticollis was the main presenting symptom of a retropharyngeal abscess, associated with non-specific symptoms such as fever and otalgia. Although rare, retropharyngeal abscesses should be suspected in patients, especially children, presenting with torticollis and fever, and radiological and endoscopic exams should be performed. Early diagnosis of retropharyngeal abscess is of paramount importance to prevent severe and potentially deadly complications such as mediastinitis or epidural abscess.