A mimicker of meningitis, retropharyngeal abscess and cervical spondylodiscitis – acute calcific tendinitis of longus colli muscle (2025)

Chin Ben Soh

Internal Medicine Department, Changi General Hospital, Singapore

Kai Xiong Lim

Internal Medicine Department, Sengkang General Hospital, Singapore

Keywords

Neck pain, odynophagia, amorphous calcium hydroxyapatite crystals deposition, calcific tendinitis of longus colli muscle

Abstract

Introduction:Acute calcific tendinitis of the longus colli muscle can present with symptoms resembling severe conditions such as meningitis, an intracranial abscess, a retropharyngeal abscess or cervical spondylodiscitis.
Case description:A 37-year-old Chinese female was admitted with neck pain, headache, fever and odynophagia, raising concerns for meningitis, a retropharyngeal abscess or cervical spondylodiscitis. The physical examination was unremarkable except for restricted neck movement and tenderness over right upper paravertebral area. Laboratory investigations were unremarkable. A CT scan of the neck showed nodular calcification just below the C1 anterior arch; MRI with contrast revealed T2-weighted hyperintensity with enhancement in the retropharyngeal space, along with minor oedema over the adjacent longus coli muscle. A final diagnosis of acute calcific tendinitis of longus colli was established, based on the radiological findings and clinical response to treatment.
Discussion:Acute calcific tendinitis of the longus muscle is a rare inflammatory condition caused by the deposition of amorphous calcium hydroxyapatite crystals in the anterior C1–C2 disc space. Due to its anatomical location, inflammation will result in triggering similar symptoms as in meningitis, an intracranial abscess, a retropharyngeal abscess or cervical spondylodiscitis. CT and MRI imaging are the gold standard for diagnostic investigation; there are no formal treatment guidelines, and management is conservative, primarily involving analgesia.
Conclusion:Clinicians should be aware that acute calcific tendinitis of the longus muscle can present with symptoms that mimic other severe conditions such as meningitis, an intracranial abscess, a retropharyngeal abscess or cervical spondylodiscitis.

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