Introduction: Brachial plexus palsy is often unilateral and due to obstetric trauma during delivery. Bilateral brachial plexus palsy is very rare in neonates. The other causes are familial congenital brachial plexus palsy, maternal uterine malformation, congenital varicella syndrome, osteomyelitis, exostosis of the first rib, tumors and hemangioma in the region of the brachial plexus. We described here a 25-day neonate, who presented with bilateral flaccid paralysis of upper extremities due to retropharyngeal abscess.

Case: A 25-day-old term male neonate, born with a birth weight of 2.5 kg, presented with complaints of paucity of movements of the bilateral upper limb. The baby was born in a private hospital by uncomplicated caesarian section. Physical examination revealed flaccid paralysis in upper extremities, dyspnea, cyanosis and lymphadenopathies in the bilateral cervical areas. There was no fever history. Cervical magnetic resonance imaging showed multiloculary abscess within the retropharyngeal area causing compression to airway. The lesion was extending into the upper mediastinum and both paraspinal areas, especially C6-C7 noral foramina. These abscess were drained and given to the patient antibiotics (vancomisin-meropenem and metronidazol) six-weeks longer. Clinical and radiological improvement was observed after three months of treatment. There is no neurological sequel after six weeks of treatment.

Discussion: We described a male neonate presented with flaccid paralysis in upper extremities due to wide retropharyngeal abscess and involvement of bilateral spinal root ganglions of C6-C7.  We would like to emphasize that retropharyngeal abscess can be a reason of brachial plexus palsy in neonates even its rarity.