Multiple Deep Neck Abscesses Developed in a Case of Acute Myeloid
Leukemia, Proposed as a Chemotherapy Related Complication, A
Case Report
Daniel Chai Z.C., Nur Izzati Ishak., Eugene Wong H.C
Otorhinolaryngology Department, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah
Received: 03 December 2025; Accepted: 09 December 2025; Published: 18 December 2025
ABSTRACT
We are describing a peculiar case of multiple deep neck abscesses developed in a young 25 years old lady, who
is a case of newly diagnosed Acute Myeloid Leukemia (AML) post completion of Daunorubicin chemotherapy
regime. The subject had initial bilateral neck swelling which worsened, whereby serial follow up radiological
investigation demonstrated multiple deep neck collections. Abscesses were drained surgically, particularly one
which is located in the nasopharynx is visually described. The main bulk of this article is dedicated to explore
and link various factors which may contribute to the transformation of tumorous lymph nodes into full blown
abscesses.
INTRODUCTION
Deep neck abscess is a condition whereby pus is accumulated in potential spaces and fascia planes in the neck
deep to the investing fascial layer, it is a condition with high rate of mortality and morbidity, though rarely
associated with chemotherapy, the link has previously been reported [8]. Immunodeficient populations has been
known to have higher propensity for abscess formation, due to the inadequacy of immune response to contain
an infection, therefore in the case of infection in the neck region, they tend to become more widespread, often
extend beyond a particular deep neck space, hence, as compared to more common cases of neck abscess seen in
paediatrics resulting from suppurative process of lymph nodes, deep neck abscesses in adult tend to be
multispace, which increases the rate of complication [3][4]
.
The mainstay treatment for deep neck abscesses in adults should be surgical drainage in concurrent with
empirical IV antibiotic therapy, Surgical drainage techniques however is not always straightforward, particularly
abscesses involving retropharyngeal, parapharyngeal, parotid, peritonsillar and submucosal spaces, therefore
surgical approach towards draining an abscess often individualized and tailored for each patient, correlating to
a surgeon’s preferences, skill and experience. As for justification of empirical antibiotics, most evidence was
derived from readily available clinical and microbiological data, such as Brito et al 2017, a retrospective study,
which will be discussed further in the discussion section [1].
Case
A 25 years old nulliparous lady with underlying chronic tonsillitis, referred by Emergency Service Department
to Otorhinolaryngology (ORL) team with a history of acute onset bilateral neck swelling, swinging fever, sore
throat and general weakness for 2 weeks duration, symptoms of which did not improve with a course of oral
antibiotic from a general practitioner. A further history of palpitation, reduced effort tolerance and persistent
lightheadedness from systematic review hinted a concurrent anemic state. On general inspection the patient
appeared pale and lethargic, neck examination revealed tender and multiple enlarged lymph nodes bilaterally,
on the right side noted at level II largest node measuring 6x3cm and on the left noted at level II with largest node
measuring 3x3cm. Full blood count investigation at the emergency unit noted severe anemia with hemoglobin
level of 3.4 g/dL (normal range 12.1 - 15.1g/dL), alongside significant leukocytosis 167.2 x 109/L (normal range
4.0 - 10.0 x 109/L). With neck abscess in mind as working diagnosis, first contrasted Computed Tomography
(CT) neck was done, however no typical rim enhancing hypodense collections noted, instead, it showed bilateral
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