A 3-Year-Old Male Presenting With Sore Throat and Torticollis

摘要

A 3-year-old vaccinated male with no significant past medical history presented to thepediatric emergency department (ED) with a chief complaint of cough. By history, he had acough and nasal congestion for 1 week and a sore throat for the past 24 hours. There was nohistory of fever or dyspnea. His history was also negative for trauma or recent travel. Hewas tolerating solids and liquids well. He was taking a cough suppressant and ibuprofen withsome symptomatic relief. In the ED, he was noted to be well appearing, afebrile, andhemodynamically stable, with the following initial vital signs: temperature 36.7°C, pulse113, respiratory rate 23, pulse oximetry 98% on room air. His physical examination wasremarkable for nasal congestion and an erythematous pharynx. He was able to drink fluids andwas initially discharged home with a diagnosis of a viral syndrome. Three days later, hepresented to another pediatric ED with congestion, sore throat, and now torticollis. Heawoke that morning with limited range of motion of his neck and some drooling. He had atactile fever the day prior which self-resolved. There was no history of vomiting. On thispresentation, he had the following vital signs: temperature 37.5°C, pulse 121, bloodpressure 102/60, respiratory rate 24, pulse oximetry 100% on room air. His physicalexamination was remarkable for a well-appearing and well-hydrated child with diffuse necktenderness without associated lymphadenopathy. In addition, he had left-sided torticollis.There was no significant trismus or evidence of meningismus. Laboratory evaluation wasremarkable for an elevated WBC (24.1 K/µL), an elevated CRP (2.07 mg/dL), mild hypoglycemia(65 mg/dL), and slightly low serum bicarbonate level (18 mmol/L). Due to concerns for apossible retropharyngeal abscess, a soft tissue neck plain film was obtained. This revealeda diffuse paravertebral swelling and a 2.2 cm linear radiopaque density (Figure 1). This density was visualizedon the lateral view only which was concerning for a possible foreign body. On furtherquestioning with family, the patient’s mother admitted that the patient had been eating fishearlier in the week. He was given a dose of antibiotics and transferred to another pediatricfacility for a consultation with a pediatric otolaryngology (ENT) surgeon.