Case description:
A 67-year-old man with a 10-year history of oropharyngeal cancer treated
with chemoradiotherapy (70 Gy) presented with a five-week history of
fever and neck pain. Past medical history revealed cervical
osteomyelitis (C1/C2) four years ago. He was afebrile and had normal
vital signs. Physical examination showed limitation of cervical range of
motion in all directions due to pain. Laboratory examination
demonstrated an elevated erythrocyte sedimentation rate (30 mm/h)
without leukocytosis. Cervical magnetic resonance imaging revealed a new
deformity at the C3-C4 vertebral endplates with hyperintense signals at
C3/C4 intervertebral discs on T2 (Figure A). These findings were
consistent with a diagnosis of recurrent cervical osteomyelitis.
We described a case of recurrent cervical osteomyelitis in a patient
with oropharyngeal cancer following radiation therapy. Although only
14% of all vertebral osteomyelitis cases involve the cervical spine,
cervical osteomyelitis has the highest risk for neurologic complications
(i.e., motor weakness or paralysis).1 Radiation
therapy for primary head and neck malignancies, especially when given at
a high dose, is a known risk factor for osteomyelitis at the irradiated
site.2 The pathophysiologic mechanisms of
radiation-induced osteomyelitis include osteoblast and osteoclast
inhibition, vascular and lymphoid tissue damage, and mucosal ulceration,
resulting in an increased susceptibility to
infection.3
This case highlights the importance of considering cervical
osteomyelitis as a differential diagnosis for neck pain in patients who
underwent radiotherapy for early diagnosis and management, thereby
preventing the development of potentially debilitating neurologic
symptoms.