Cold Abscess

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Cold Abscess


an accumulation of pus in a limited region, without such local or general manifestations of an inflammatory reaction as pain, reddening of the skin, or fever, which are typical of an ordinary abscess.

Cold abscesses occur mainly during certain stages of actinomycosis or of tuberculosis of bones and joints. In tuberculosis of bones, and most commonly in spondylitis, a cold abscess tends to become diffused in adjacent tissues owing to the pressure of the pus, and to form a wandering abscess. For example, in tubercular spondylitis of the lumbar region of the spine, a cold abscess may extend to the iliac region or to the upper third of the thigh; it becomes discernible only when a subcutaneous tumor-like formation appears. If the abscess is not treated it may break through the soft tissues and skin, form fistulas that are slow to heal, and discharge a characteristic granular type of pus containing the abscess’s causative agents.

A cold abscess is treated at its original site. Surgical treatment involves puncturing or incising the region of the swelling in order to remove the purulent necrotic mass and to introduce chemotherapeutic agents.

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A provisional diagnosis of cold abscess was considered initially and Ziehl-Neelsen stain was performed to rule out the presence of AFB but the possible mycotic etiology was not considered.
Tuberculous lymphadenitis has a broad spectrum of presentation; from solitary to multiple lymph node site involvement, which may be matted or discrete and may involve any group or may present as a cold abscess or discharging sinus.
This appearance may be typical of a cold abscess of a superficial nerve in leprosy.
Others include Streptococcus and Acinetobacter in few cases and one case of tuberculous lymphadenitis with cold abscess.
A provisional diagnosis of borderline lepromatous leprosy with a metastatic cold abscess was kept.
Extrapulmonary tuberculosis in the breast may present as a mass, discharging sinus, cold abscess or non-healing ulcers mimicking carcinoma.
Nerve abscess may occur in various forms of leprosy due to caseation of nerve fasciculi leading to cold abscess formation.
The case is a documented because of the rarity of reports on retropharyngeal abscess in the literature and because of the large size of a retropharyngeal cold abscess sufficient to cause respiratory distress in an adult patient.