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- general medicine (see internal medicine)
- bone diseases
- musculoskeletal disorders
- education and training (see medical education and training)
A 44-year-old man with a 3-day history of limited range of motion of the bilateral shoulders, neck pain, dysphagia and mild fever presented to our emergency department. He had no previous significant medical history. He also denied any other neurological problems. He had normal levels of consciousness and orientation. On physical examination, the patient exhibited limited range of motion in rotation, severe nuchal rigidity without meningeal irritation, including Kernig’s sign and Brudzinski’s sign. Cervical CT showed irregular shaped calcification anterior to the C1-C3 level with associated soft tissue swelling (figures 1 and 2A). Laboratory examination revealed an elevated C reactive protein level of 7.84 (normal range: 0–0.14 mg/dL) and white blood cell counts of 12 000. On the basis of the clinical and characteristic radiographic findings, the patient was diagnosed with acute calcific retropharyngeal tendinitis. Acute calcific retropharyngeal tendinitis is an inflammatory condition due to calcium hydroxyapatite crystal deposition in the longus colli tendons.1 Acute calcific retropharyngeal tendinitis is relatively rare, and can often be misdiagnosed as other serious conditions, including bacterial meningitis, pyogenic spondylitis, cervical fractures and retropharyngeal abscess.2 The standard treatment is based on short-term administration of non-steroidal anti-inflammatory drugs (NSAIDs) and neck brace immobilisation with the soft cervical collar. Recently, application of histamine H2-receptor antagonists (H2 blocker) has been reported to be useful.3 His symptoms improved 4 days after beginning the treatment with NSAIDs and H2 blocker. Three months later, repeat CT revealed that the calcification and soft tissue swelling had disappeared (figure 2B).
Contributors HM contributed to write manuscript and discussion. YS, ES, YK and MK also contributed to discussion and patient care.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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