Case Presentation: A 54-year-old male with hereditary spherocytosis, status-post splenectomy presented to the emergency room complaining of acute onset neck pain for 2 days. This was localized on the left side of his neck and associated with odynophagia. The patient endorsed mild headache but no photophobia or fever. His vital signs were stable with a temperature of 36.4 degree Celsius. Examination revealed no stridor. Oropharynx was clear without inflammation. Neck was rigid and tender to palpation but free of mass or swelling. Laboratory was significant for WBC of 11.8 cells/mm3. Electrolytes, renal and hepatic panels were all unremarkable. CT soft tissue neck with contrast showed an ill-defined hypodense collection tracking along the retropharyngeal space with the presence of a pre-dens calcification and a discrete and elongated prevertebral soft tissue thickening from C1 to C5 consistent with longus colli tendinitis. Due to his immuncompromised status, he was evaluated by Otolaryngology and subsequently performed a flexible fiberoptic laryngoscopy that showed no evidence of abscess, mass or ulceration. The patient was successfully managed with oral NSAIDs and discharged home with symptomatic relief.
Discussion: Acute calcific tendinitis of the longus colli is a benign and self-limited inflammatory condition. The longus colli is a muscle situated on the anterior surface of the vertebral column, between the atlas and the third thoracic vertebra. Deposition of calcium hydroxyapatite crystals in the tendon fibers of this muscle produces an inflammation manifesting as neck pain (which can be subacute to acute in onset), dysphagia and/or odynophagia. The neck pain can be severe and accompanied with stiffness. It is often localized posteriorly or laterally in the neck as in our patient. It may be accompanied by fever. Due to its inflammatory nature, mild elevations in ESR along with mild leukocytosis can be present. The differential diagnosis is broad and includes serious conditions that present with similar clinical features such as meningitis, retropharyngeal abscess, and neoplasm. CT remains the gold standard for establishing the diagnosis as it detects both crystal deposition and edema at the longus colli tendon. Treatment is conservative since this is a self-limiting condition that spontaneously resolves in 1-2 weeks. Symptom alleviation can easily be achieved with oral non-steroidal anti-inflammatory medications.
Conclusions: This case aims to increase awareness of this uncommon clinical entity and its self-limited course. Though a benign condition, acute calcific tendinitis of the longus colli simulates a number of serious and life-threatening diseases. Understanding its aseptic inflammatory nature prevents unnecessary antibiotics administration as well as invasive interventions in the retropharyngeal space. Management is conservative with oral anti-inflammatory agents, usually NSAIDs.