Supraglottic Laryngeal Abscess of Idiopathic Etiology Secondary to Community-Acquired, Methicillin-Resistant Staphylococcus aureus

Abstract

Objectives: Prior to the widespread use of antibiotics, laryngeal abscesses typically presented secondary to systemic illnesses. Today, laryngeal abscesses are rarely observed, and most result from disease processes intrinsic to the larynx, such as airway instrumentation or malignancy. This report describes the unique case of an arytenoid abscess of insidious etiology. A supraglottic laryngeal abscess of this anatomic location has not previously been described in the literature and is of particular interest given the increasing prevalence of community acquired, methicillin-resistant Staphylococcus aureus (MRSA). We seek to characterize the presentation, work-up, and treatment of this condition. Methods: A single case of an arytenoid abscess is described. The electronic medical record was used to collect demographic and clinical information. Results: The patient had no prior history of laryngeal disease or airway instrumentation; however, her past medical history was significant for poorly controlled type 1 diabetes mellitus, as well as alcohol and methamphetamine abuse. Severe dysphagia and hoarseness prompted computerized tomographic imaging of the neck, which revealed a laryngeal abscess. Incision and drainage under direct laryngoscopy identified an abscess involving the right arytenoid with extension into the interarytenoid space. Cultures at the time of surgery grew MRSA, and biopsy of the abscess cavity was negative for malignancy. Following surgical drainage and appropriate antibiotic therapy, the patient recovered without long-term sequelae. Conclusions: Laryngeal abscesses are rarely encountered in modern practice. This case offers a previously undescribed example of an idiopathic arytenoid abscess in the setting of an increasingly common infection, community acquired, MRSA.