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Tularaemia presenting as parapharyngeal abscess: case presentation

Published online by Cambridge University Press:  09 March 2012

S Koc ,
L Gürbüzler ,
H Yaman ,
A Eyibilen ,
N Salman  and
A Ekici
S Koc*
Affiliation:
Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
L Gürbüzler
Affiliation:
Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
H Yaman
Affiliation:
Department of Otorhinolaryngology, Düzce University School of Medicine, Turkey
A Eyibilen
Affiliation:
Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
N Salman
Affiliation:
Department of Otorhinolaryngology, Ankara Children's Hematology and Oncology Hospital, Turkey
A Ekici
Affiliation:
Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
*
Address for correspondence: Dr Sema Koc, Department of Otorhinolaryngology, Gaziosmanpasa University School of Medicine, Tokat, Turkey Fax: +90 3562133179 E-mail: [email protected]
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Abstract

Objective:

We report an extremely rare case of the oropharyngeal form of tularaemia, causing a parapharyngeal abscess.

Case report:

A 48-year-old woman presented with fever, sore throat, breathing difficulty and a right-sided neck swelling. This mass had previously been treated with penicillin without response, and had already been surgically drained once in another hospital. On physical examination, the tonsils were exudative and hypertrophic and the pharynx was hyperaemic. A fluctuant, 4 × 4 cm mass was seen on endoscopic examination, originating from the left parapharyngeal area and protruding towards the pyriform sinus, and partly obstructing the airway. Microagglutination test antibody titres for Francisella tularensis were positive (1/1280). The patient healed completely after definitive drainage of the abscess and antimicrobial therapy for 14 days (streptomycin, 2 × 1 g intramuscularly).

Conclusion:

Tularaemia should be considered in the differential diagnosis of patients presenting with tonsillopharyngitis, cervical lymphadenitis and parapharyngeal abscess who do not respond to treatment with penicillin, even if they do not live in an endemic region.

Keywords

TularemiaPharyngeal DiseaseAbscessDiagnosisOropharynxFrancisella Tularensis
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 5 , May 2012 , pp. 535 - 537
Copyright
Copyright © JLO (1984) Limited 2012

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