Cervical lymph node abscess with prevertebral extension into the upper mediastinum – A rare complication three weeks after resolved scarlet fever in a 3-year-Old

Abstract

Scarlet fever is an acute infectious disease caused by Streptococcus pyogenes (Group A β-hemolytic streptococci), typically affecting children between 5 and 15 years of age [1]. It is characterized by fever, pharyngitis, a diffuse erythematous rash, and “strawberry tongue” [2]. Although the disease is generally self-limiting with appropriate antibiotic therapy, complications can still arise, ranging from mild (otitis media) to severe, including suppurative lymphadenitis, peritonsillar abscess, and, more rarely, deep neck space infections [3,4]. Deep cervical infections are a known but uncommon complication of streptococcal infections in children and carry a significant risk due to their proximity to vital structures and the potential for descending spread into the mediastinum via fascial planes [5]. Such infections may present subtly, often after initial recovery from the primary illness, and require a high index of suspicion, especially when patients present with torticollis, neck swelling, or signs of systemic toxicity [6]. In this report, we present a rare case of a 3-year-old child who developed a massive cervical lymph node abscess with necrosis and prevertebral extension into the upper mediastinum, three weeks after a clinically resolved scarlet fever infection. This case highlights the importance of early recognition and aggressive management of post-infectious complications, even when the primary illness appears fully resolved.