B. Spontaneous lymphorrhea
Because of the rash, acute neck swelling, large cervical fluid accumulation with mediastinal infiltration, and hyperleukocytosis, we treated the patient as if he had cervical necrotizing fasciitis. He immediately underwent an operation. Orotracheal intubation was easily performed. The left cervicectomy and opening of the superficial fascia revealed a milky fluid that was coming from all the soft tissues. The introduction of the surgeon’s finger allowed an easy and large retropharyngeal and retroesophageal dissection from the skull base to the posterior mediastinum.
Samples were sent to bacteriology, mycobacteriology, anatomopathology, and biochemistry laboratories. Two lavage modules were fixed, and the cervicectomy was not closed. Another incision to wash and drain the anterior mediastinum and a tracheostomy were performed. Amoxicillin and clavulanic acid, 3 grams per day, were administered.