Retropharyngeal Abscess in Children: An Uncommon Presentation of a Central Skull Base Osteomyelitis Secondary to A Subclinical Tonsillitis

Central skull-base osteomyelitis (CSBO) is a life-threatening condition that requires emergent intervention. Retropharyngeal abscesses should also be addressed as early as possible since mortality increases in the setting of airway compromise and oropharyngeal narrowing. Retropharyngeal blemish's clinical symptoms are generally non-specific, including fever, neck swelling/pain, drooling, swallowing difficulties, and the most common presentation is bulging of the posterior aspect of the oropharyngeal wall in 37 % of cases. Headache is a prevalent chief complaint of the adult population in the emergency department, whereas it is rarely reported yet should be aggressively addressed when it comes to children under 10 years of age. Authors herein describe a retropharyngeal abscess with central skull base osteomyelitis in a girl of 7 who presented with progressive headache and neck pain. We underline the importance of pushing for imaging in a child of 7 years of age able to exhibit the symptom of headache. Children are usually challenging to understand, especially for their limited ability to explain symptoms. So, when a child can describe a complex symptom such as a headache, he should be taken seriously, especially in the emergency care setting, and indeed, emergency care providers should ask for further imaging. CT scan with IV contrast is the ultimate modality to diagnose an abscess in the emergency department.