Clinical Photo of The Week: Vol3, No3

The following case was presented in a recent (Vol3,No3) edition of otorhinolaryngology news:
An 11-year old female was referred on account of 3 weeks history of progressive right sided neck swelling not responsive to conventional antibiotics. she had associated fever, odynophagia and dysphagia, but no preceding dental or throat symptoms. Examination revealed high fever, (T=39.80Celsius), pallor, tinge of jaundice, dry coated tongue with thick adherent whitish plaque on the dorsum, trismus and the neck sign demonstrated in this picture. Her ESR was markedly elevated, Her PCV was 20, Only anomaly on E/U/Cr was hypokalemia (K+ = 2.5 mEq/L). Her retroviral screen was negative.
Diagnosis: Deep Neck Infection (DNI). This patient had an initial parapharyngeal space infection which subsequently spread to the submandibular and masseteric spaces. Click Here for factors affecting the bacteriology in DNI.