(536) Vallecular Abscess in a Patient with History of Hidradenitis Suppurativa

Introduction: Vallecular abscess is a rare purulent accumulation located anterior to the epiglottis and posterior to the tongue base. Here we exhibit a patient with a history of hidradenitis suppurativa, a skin condition known to cause abscesses, who presented with an enlarging neck mass that was found to be a vallecular abscess.

Methods: This is a novel retrospective case presentation

Results: A 30-year-old female with a history of obesity, diabetes, and hidradenitis suppurativa presented with minor shortness of breath, hoarseness, cough, poor appetite, otalgia, and odynophagia for 4 days. Physical examination revealed muffled voice, edema of the neck, and tenderness to palpation of bilateral submandibular and submental regions. White blood cell count was elevated at 12.6 K/uL. A CT Neck with contrast was obtained, which showed a 2.2 x 2.3 cm midline abscess near the base of tongue. With the history of known abscesses that had often cleared with antibiotic use, she was initially treated with IV clindamycin and Levaquin. After two days of no significant clinical improvement with the IV antibiotics, patient was taken to the operating room for direct laryngoscopy and incision and drainage of the abscess. A Dedo-Pilling laryngoscope was used to visualize the abscess, which was found to be located in the vallecula. The abscess was drained via an extended 18-gauge needle and purulence was sent for culture. Post operatively, white blood cell count normalized and pain, odynophagia, otalgia, and breathing improved. Patient was discharged after two more days was IV antibiotics and has not had recurrence of vallecular abscess.

Conclusions: Vallecular abscess is a rare diagnosis on the long list of possible differentials for an enlarging neck mass. Patients with hidradenitis suppurativa may be more likely to develop an abscess in this location than the general public. Knowledge of disease differentiation, diagnostic imaging, and medical and surgical intervention are essential for evaluation and treatment. Large vallecular abscesses can lead to dysphagia and airway obstruction and may require surgical intervention for removal.