What is the most likely cause of elevated Liver Function Tests (LFT) with a retropharyngeal abscess?

From the Guidelines

Elevated liver function tests (LFTs) in a patient with retropharyngeal abscess is most likely due to systemic inflammatory response syndrome (SIRS) or sepsis, as supported by the most recent evidence from 2023 1. When a patient presents with a retropharyngeal abscess, the infection can trigger a widespread inflammatory response that affects multiple organ systems, including the liver. The liver dysfunction occurs as a result of inflammatory cytokines, endotoxins, and altered hepatic blood flow during the infectious process.

Key Considerations

• The liver function tests are often obtained as part of standard laboratory panels in asymptomatic and symptomatic patients, and alteration in the biochemical markers of hepatocyte damage or bile flow indicate hepatobiliary insult rather than a measurement of liver function 1.
• Hepatocellular predominant abnormal liver function tests are reflected as an increase in aminotransferases, ALT, and AST, which can be caused by diffuse hepatic infiltration, acute hepatitis, or toxic or ischemic injury 1.
• Pathologically increased levels of ALP may occur in cholestatic liver disease, which can show elevated ALP with or without elevated bilirubin, and concomitantly elevated GGT can help confirm that an elevated ALP originates from the liver and indicates cholestasis 1.

Management

• Management should focus on treating the primary infection with appropriate antibiotics, such as a combination of ampicillin-sulbactam 3g IV every 6 hours or clindamycin 600-900mg IV every 8 hours plus a third-generation cephalosporin, along with surgical drainage of the abscess.
• Supportive care including IV fluids and close monitoring of liver function is essential.
• The LFTs typically normalize once the infection is controlled.
• If liver function continues to worsen despite appropriate treatment of the abscess, other causes of liver dysfunction should be investigated, including medication hepatotoxicity, viral hepatitis, or pre-existing liver disease.

From the Research

Elevated LFT with Retropharyngeal Abscess

• The provided studies do not directly address the relationship between elevated Liver Function Tests (LFT) and retropharyngeal abscess 2, 3, 4, 5, 6.
• However, it can be inferred that retropharyngeal abscess is a serious condition that requires early diagnosis and treatment to prevent complications, and elevated LFT may be a secondary effect of the infection or the treatment used 2, 3, 4, 5, 6.
• The most common causes of retropharyngeal abscess include:
  • Impaction of a foreign body, especially fishbone 2
  • Trauma 3, 4
  • Upper respiratory infections, especially in children 3, 4, 5
  • Dental infections 3, 6
• The most common presenting symptoms of retropharyngeal abscess include:
  • Odynophagia (painful swallowing) 2, 3, 4
  • Neck pain 2, 3, 4
  • Fever 2, 3, 4
  • Dyspnoea (difficulty breathing) 2
  • Stridor (a high-pitched sound while breathing) 2
  • Trismus (lockjaw) 2
  • Neck stiffness 2
• The treatment of retropharyngeal abscess typically involves:
  • Surgical drainage of the abscess 2, 3, 4, 5, 6
  • Antibiotic therapy 2, 3, 4, 5, 6
  • Supportive care, such as pain management and hydration 2, 3, 4, 5, 6