A Rare Case of Post-Intubation Cricoid Cartilage Abscess: Diagnosis and Therapeutic Approach.

Abstract

We report a life-threatening post-intubation cricoid abscess in a 29-year-old diabetic male, highlighting the challenges of airway compromise management. Following 7 days of mechanical ventilation for severe pneumonia, the patient developed acute dysphonia, inspiratory stridor, and progressive dyspnea culminating in resting respiratory distress (ambulation <10 m). Bedside laryngoscopy revealed a 70% obstructing subglottic mass with inflammatory changes. Contrast computed tomography identified a 23 mm rim-enhancing cricoid abscess causing critical airway stenosis. Immediate tracheostomy secured the airway, with subsequent operative drainage yielding Streptococcus species resistant to first-line antibiotics. Targeted IV ceftazidime and oral ciprofloxacin achieved resolution, permitting decannulation at 21 days. This case underscores 3 critical lessons: (1) the heightened infection risk in diabetics post-intubation, (2) the value of rapid endoscopic airway assessment in post-extubation dyspnea, and (3) the necessity of culture-directed therapy in deep neck space infections. Unlike typical laryngotracheal complications (eg, granulomas or stenosis), abscess formation at the cricoid represents a rare but potentially fatal etiology of post-intubation airway obstruction requiring multidisciplinary intervention. Early imaging and surgical drainage proved pivotal in preventing catastrophic outcomes in this immunocompromised host.