title: Retropharyngeal abscess in the setting of immune modulation for rheumatoid arthritis.
abstract: OBJECTIVE
  At the conclusion of this presentation, the participants should be familiar with the management of serious head and neck infections occurring inpatients on biologic agents for rheumatoid arthritis.
  
  
  OBJECTIVE
  Present a case of retropharyngeal abscess managed in a patient on abatacept, a T cell immune modulator, for rheumatoid arthritis. Review the literature on the relationship between biologic agents for rheumatoid arthritis and head and neck infections.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Retrospective case review including a review of the relevant literature.
  
  
  RESULTS
  The case of a 62-year-old woman with retropharyngeal abscess is presented. Her medical history was significant for rheumatoid arthritis treated with abatacept, a T-cell immune modulator. She presented with progressive odynophagia and neck pain, and a computed tomography scan revealed large retropharyngeal abscess extending to the superior mediastinum with bilateral pleural effusions. Transcervical incision and drainage was performed and infectious disease consultation was obtained. Full recovery was achieved after a month long course of intravenous antibiotics.
  
  
  CONCLUSIONS
  Biologic agents that achieve selective immune modulation have revolutionized the treatment of rheumatoid arthritis. However, there is a small but significant risk of serious infection that accompanies these drugs. Otolaryngologists should be vigilant for signs and symptoms of serious head and neck infection in patients who are on biologic agents for rheumatoid arthritis. Management of these patients must account for their diminished immune response to infection.
authors.affiliation: Division of Head and Neck Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Kakarala
authors.forename: Marlene L
authors.initials: ML
authors.lastname: Durand
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Emerick
mesh_terms: D000069594:Abatacept; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004322:Drainage; D005260:Female; D006801:Humans; D018796:Immunoconjugates / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008875:Middle Aged; D017703:Retropharyngeal Abscess / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D018796:Immunoconjugates; D007166:Immunosuppressive Agents; D000069594:Abatacept