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Retropharyngeal TB Abscess — SCE Infectious Diseases MCQ

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ModerateTuberculosisRetropharyngeal TB AbscessSCE Infectious Diseases

A 55-year-old man develops a retropharyngeal abscess. CT neck shows a rim-enhancing collection posterior to the pharynx with prevertebral extension from C2 to C5. He has no history of trauma or dental infection. He emigrated from India 5 years ago. What organism should be specifically considered?

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Correct answer: C — Mycobacterium tuberculosis (retropharyngeal cold abscess from cervical spine TB)

A retropharyngeal abscess with prevertebral extension spanning multiple cervical vertebral levels in a patient from a TB-endemic country should raise suspicion for TB (cold abscess). Cervical spine TB can cause paravertebral abscesses that track along fascial planes to form retropharyngeal collections. These 'cold abscesses' may have minimal surrounding inflammation. CT and MRI of the cervical spine should be performed to assess for spondylodiscitis. Biopsy/aspiration for AFB smear, culture, and PCR is essential. Standard anti-TB therapy for 12 months (spinal TB duration) is required.

Reference: NICE NG33 2016 – TB; ENT-UK 2023 – Deep neck infections