A man with fever and posterior neck pain

Clinical introduction

A 40-year-old man presented with a 5-day history of severe posterior neck pain and fever of 38.3°C. He also had odynophagia. Physical examination revealed a normal active range of motion in neck anteflexion but limited extension and left rotation. Laboratory tests showed elevated white cell count (12 x10⁹/L) and C reactive protein (8.70 ng/dL). Cerebrospinal fluid analysis was normal. A lateral cervical radiograph was performed (figure 1).

Question

What is the most likely diagnosis?

A. Retropharyngeal abscess

B. Meningitis

C. Crowned dens syndrome

D. Acute calcific tendinitis of the longus colli muscle

Answer: D

Acute calcific tendinitis of the longus colli muscle: Acute calcific tendinitis of the longus colli muscle (or retropharyngeal tendinitis) is a rare inflammatory disorder characterised by calcium hydroxyapatite crystal deposition in the neck.1 The crystal deposition occurs in a different location to that seen in crowned...

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