From common to critical: intervention in herpes spine complicated by atypical infection.

Abstract

The management of gastrointestinal foreign bodies (GIFB), particularly fish bones, is a frequent reason for consultation that can lead to serious complications if not addressed promptly. The objective of this case report is to highlight the importance of accurate diagnosis, safe removal, and targeted antibiotic therapy in geriatric patients with hypopharyngeal foreign bodies. In this case, a 90-year-old female patient presented with odynophagia and dysphagia after ingesting cod. Computed tomography (CT) of the chest and neck was used as the diagnostic method of choice, revealing a hyperdense bone approximately 28 mm long impacted in the hypopharynx with adjacent inflammatory reaction, which precluded primary endoscopic removal. The patient underwent a second gastroscopy attempt with the possibility of a cervicotomy, achieving successful removal of the bone (approximately 3 cm) and abundant drainage of purulent fluid. The main complication was a polymicrobial hypopharyngeal abscess, which cultured Acinetobacter junii and Pseudomonas aeruginosa, both sensitive to ciprofloxacin. This led to an adjustment of the antibiotic treatment to anti-pseudomonal doses. Finally, we emphasize that CT is the most sensitive imaging method for these cases, that early endoscopic removal is crucial, and that the identification of opportunistic pathogens, potentially linked to the microbiota of fish such as cod, requires targeted and tailored antimicrobial management.