Spontaneous retropharyngeal abscess presenting as delirium in a frail older woman: a case-based review

ABSTRACT

Introduction

Retropharyngeal abscess (RPA) is an uncommon infection in older people, which usually presents with localized upper airway symptoms.

Case presentation

We present a case of RPA in a 69-year-old frail woman with co-morbidities, who presented atypically with delirium. She initially complained of general symptoms of malaise, body aches and general decline. Her symptoms progressed to hypoactive delirium before she started to localize her complaints to the upper airway. The delirium presentation of RPA is not commonly reported in the literature. Co-morbidities and frailty are likely to be the underlying risk factors for delirium presentation in this case. Most of the RPA cases reported in older people in the literature presented typically with localized symptoms, however these cases had lower burden of morbidities and reported no frailty. In our case report, poor mouth hygiene and dental caries were thought to be the source of infection. Early intervention with antibiotic treatment for total of four weeks resulted in a full recovery.

Conclusion

RPA may present with delirium in older people with frailty and co-morbidities. Poor oral hygiene and dental caries, if left untreated, may progress into serious deep space neck infection.

KEYWORDS:

• Older people
• frailty
• delirium
• retropharyngeal abscess
• deep space neck infection

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

AHA and PH considered the idea of the case report; MM prepared the case history; BW, MM, HK and NA conducted the literature search and extracted the data into a table; AHA and BW wrote the first draft; all authors reviewed and edited the final version of the manuscript including table, boxes and figures.

Ethics statement

Patient consent to participate was obtained.

Additional information

Funding

This paper was not funded.