Acute neck pain in the ED: Consider longus colli calcific tendinitis vs meningitis

Presented here is a rare cause of severe neck pain - acute longus colli calcific tendinitis - in a 54 year old manwho presented to the emergency department. The neck pain is due to inflammation caused by calciumhydroxyapatite crystal deposition in the tendons on the longus colli muscles. This is non-infectious. The gold standard for diagnosis is a CT neck which best shows the calcifications in the anterior vertebral column of C1-C4, where the tendons of these muscles insert bilaterally. Longus colli calcific tendinitis is not life-threatening and patients will make a full recovery after treatment with NSAIDs. However, this condition is often confused with life-threatening conditions such as infection (meningitis or retropharyngeal abscess), intracranial hemorrhage, trauma, herniation of cervical discs, or malignancy (Estimable et al. (2015) [1]). Symptoms associated with calcific tendinitis of the longus colli muscle are non-specific and include mild fever, moderate-severe headache, neck pain, and drastically reduced range of motion of the neck. More specific symptoms are the presence of dysphagia and odynophagia. Lab findings usually are significant for mild leukocytosis, and elevated ESR and CRP. Awareness of this condition by E. D. physicians can avoid unnecessary invasive interventions, increased costs, and delays that result from incorrect diagnosis and treatment. This is a unique case inwhich a patientwho was afebrile with a normal ESRwasworked up for meningitis and an intracranial process, and also empirically treated for meningitis before finally being diagnosedwith acute calcific tendinitis of the longus colli muscle in the E.D. (C) 2017 Elsevier Inc. All rights reserved.