Acute Calcific Longus Colli Tendonitis: A Mimicker Of Meningitis
INTRODUCTION: Acute calcific tendinitis (ACT) of the Longus Colli muscle also otherwise known as retro-pharyngeal tendinitis or acute calcific prevertebral tendinitis, is a self-limiting inflammatory condition presumably caused by calcium hydroxyapatite deposition in the longus colli tendon. The ACT often presents with acute posterior neck pain, neck stiffness, dysphagia, odynophagia, and mild fever. The clinical presentation can sometime be confusing and seems like patient is having signs of meningismus.
CASE PRESENTATION: A 40 year old previously healthy female presented with a day history of headache, neck pain and stiffness to the clinic. The symptoms were associated with odynophagia, dysphagia and nausea, but she denied any fever, chills, vision changes, dizziness or photophobia. Concerning for Meningitis, she was referred to the ER. CT head w/o contrast negative for anybleed/mass/inflammation. She had an LP that was unrevealing for any infectious pathology. She was discharged from the ER to home. Later she presented to the clinic for follow up, still complaining of the similar symptoms. With concerns for deep space infection versus cervical paraspinal muscle spasm, CT soft tissue neck with contrast was ordered that clinched the diagnosis.
DISCUSSION: This most commonly occurs in age group between 30-60. The exact etiology of calcium hydroxyapatite crystal deposition is still poorly understood; however, some investigators hypothesize that repetitive ischemia, trauma, and degeneration contribute to the pathogenesis of ACT. The longus colli muscle has three parts: upper-, vertical- and lower oblique fibers and is located in the prevertebral area. The ACT is an inflammatory process.