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September 2022

Am J Med. 1988 Feb; 84(2): 363-5.

Pyogenic cervical osteomyelitis presenting as a massive prevertebral abscess in a patient with rheumatoid arthritis.

McGrath H, McCormick C, Carey ME.

Department of Medicine, Louisiana State University School of Medicine, New Orleans.

Pre-existing rheumatoid arthritis appeared to have masked the diagnosis and contributed to a succession of hazardous events in a 58-year-old man with pyogenic cervical osteomyelitis. A massive prevertebral abscess and near asphyxiation finally led to the diagnosis of an indolent Staphylococcus aureus infection in a course marked by antecedent staphylococcal sepsis, a series of dangerous cervical spine chiropractic manipulations in the presence of advanced bony destruction, and, ultimately, cervical spine bony collapse and gibbus formation. The absence of myelopathy despite long-standing progressive advanced destruction is noteworthy. The roentgenologic documentation of this progression was unique. This appears to be the first fully documented case of cervical spine osteomyelitis presenting as a prevertebral abscess in a patient with rheumatoid arthritis.

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