The case of an 18-yr-old otherwise healthy adult with retropharyngeal abscess (RPA) presenting with sore throat and syncope is reported. The case illustrates that sore throat with symptoms out of proportion to oropharyngeal findings should prompt a search for pathology other than simple pharyngitis. A literature search for case reports of RPA in adults was done to derive characterizations about this disease. Adult RPA patients present with sore throat, dysphagia, neck pain and, less commonly, stridor. Adult RPA occurs as a complication of procedures or blunt trauma to the neck, or spread of infection from an adjacent focus. The incidence of underlying disease causing immunosuppression is high. RPA in adults without history of preceding trauma or coexistent illness is unusual.