Neck Mass in a Returning Traveler

A 49-year-old man, who recently completed a summer pilgrimage to Bangladesh and Saudi Arabia, with a history of diabetes presents to the emergency department of a US hospital with an abdominal wall abscess. He is given empirical double-strength trimethoprim-sulfamethoxazole twice daily for 14 days and several weeks later he returns with painful swelling of the left side of his neck associated with subjective fever and chills. On examination he is afebrile and a tender, 2-cm fluctuant neck mass is palpated, so a contrast computed tomography scan of the neck is performed. The patient is given oral clindamycin with plans for ultrasound-guided incision and drainage by an otorhinolaryngologist but after 8 days of empirical clindamycin, he returns to the emergency department with worsening neck pain. Here, Christini and King discuss the management of the neck mass in this returning traveler.