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Parapharyngeal abscess complicated by endophthalmitis: a rare presentation of nasopharyngeal carcinoma

Published online by Cambridge University Press:  14 May 2007

V E S Tan ,
J Jeevanan  and
B R Lee
V E S Tan*
Affiliation:
Department of Otorhinolaryngology – Head & Neck Surgery, Faculty of Medicine, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
J Jeevanan
Affiliation:
Department of Otorhinolaryngology – Head & Neck Surgery, Faculty of Medicine, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
B R Lee
Affiliation:
Department of Pathology, Faculty of Medicine, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
*
Address for correspondence: Dr Vincent Tan Eng Soon, Department of Otorhinolaryngology – Head & Neck Surgery, Faculty of Medicine, Hospital Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia. Fax: +603 91737840 E-mail: veelian@streamyx.com
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Abstract

Objective:

We report an extremely rare case of nasopharyngeal carcinoma presenting as a lateral neck abscess complicated by endogenous bacterial endophthalmitis. Endogenous bacterial endophthalmitis complicating a neck abscess has not been reported in the recent English literature. We discuss the possible pathophysiology of neck abscess as a presenting feature of nasopharyngeal carcinoma, and the relationship between the parapharyngeal abscess and endogenous bacterial endophthalmitis.

Case report:

A middle-aged Chinese man presented with a left neck abscess associated with progressive vision deterioration and proptosis of the left eye. Incidentally, his random blood glucose was found to be elevated. Nasal endoscopy also revealed bilateral bogginess in the fossa of Rosenmuller. A diagnosis of left neck abscess with endogenous endophthalmitis associated with underlying diabetes mellitus was made. A computed tomography scan of the neck showed a left parapharyngeal abscess. Incision and drainage of the abscess together with biopsy of the nasopharynx was performed. Due to the non-salvageable condition of the left eye, evisceration was also performed. Pus culture studies from the neck abscess grew Klebsiella pneumoniae, and nasopharyngeal biopsy revealed undifferentiated carcinoma.

Conclusion:

Nasopharyngeal carcinoma is endemic in South East Asia and can have multiple, varied presentations. Therefore, in this setting, the clinician should have a high index of suspicion, especially in a patient from the Chinese ethnic group.

Keywords

NeckAbscessNasopharynx NeoplasmsDiabetes Mellitus
Type
Clinical Record
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 8 , August 2008 , pp. 867 - 870
Copyright
Copyright © JLO (1984) Limited 2008

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