42-year-old woman with a history of pulmonary embolism and Antiphospholipid syndrome on lifelong anticoagulation with warfarin presented with severe neck pain and headache for five days. Examination revealed an ill appearing woman, febrile to 101F with excruciating neck pain aggravated by movement in all directions and swallowing. Labs were remarkable for an elevated CRP of 65 and the absence of leukocytosis. Lumbar puncture was deferred due to an INR of 2 and the patient was started on broad-spectrum antibiotics for empiric treatment of meningitis. Subsequent computer tomography of the neck with contrast demonstrated a confluent area of calcification within the prevertebral soft tissues anterior to the odontoid process and inferior to the anterior arch of the C1 ring consistent with calcific longus colli tendonitis. Empiric antibiotics were discontinued and the patient was started on high dose NSAIDs that provided minimal relief of symptoms. Oral steroids were initiated leading to resolution of symptoms with a concurrent decrease in the level of CRP.
Discussion:
Acute calcific longus colli tendonitis is an under diagnosed etiology of severe neck pain with a standardized incidence of 1.31 per 100,000 person – years [1]. The unique nature of this case is that along with neck pain the patient presented with an associated fever mimicking meningitis placing this high on the differential. In the absence of familiarity with this condition this patient would have been misdiagnosed and subjected to a diagnostic lumbar puncture and the administration of broad spectrum antibiotics instead of a simple regime of high dose NSAIDS and oral steroids.
Conclusions:
Physicians should always bear in mind acute calcific longus colli tendonitis when patients present with symptoms mimicking meningitis since knowledge of this condition can often prevent the deleterious use of antibiotics and invasive procedures.