Pain in the neck

Description

A girl aged 4 years presented with a 1-month history of headache, malaise and episodes of unsteady gait. She appeared well with normal observations. She had limited neck extension and lateral rotation with normal neurological examination. A CT head showed no space-occupying lesion and the patient was discharged.

She re-presented a week later with neck pain, stiffness and intermittent fever. There were no signs of upper airway obstruction and she continued to eat as normal. Repeat CT of the neck and MRI revealed significant thickening of the retropharyngeal soft tissue with collection in keeping with a retropharyngeal abscess causing significant narrowing of the pharynx along with osteomyelitis of the clivus (see figure 1).

Figure 1

CT neck with contrast showing retropharyngeal abscess and osteomyelitis of the clivus.

She was started on broad-spectrum intravenous antibiotics and surgical drainage was attempted but...

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