Prevertebral abscess associated with meningitis: Double cause of neck stiffness

Hidenori Higashi; Ken-Ichiro Kobayashi; Anna Eto; Tadahiro Goto

doi:10.1016/j.idcr.2022.e01549

Prevertebral abscess associated with meningitis: Double cause of neck stiffness

IDCases. 2022 Jun 28:29:e01549. doi: 10.1016/j.idcr.2022.e01549. eCollection 2022.

Authors

Hidenori Higashi¹, Ken-Ichiro Kobayashi², Anna Eto³, Tadahiro Goto^{4

5}

Affiliations

¹ Department of Emergency and Critical Care Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
² Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
³ Department of Otolaryngology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan.
⁴ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
⁵ TXP Medical Co., Ltd., Tokyo, Japan.

Abstract

While neck stiffness belongs to the classic triad of meningitis symptoms together with fever and altered mental status, it can also be attributed to inflammation from prevertebral space infection. We describe a difficult-to-diagnose case of prevertebral abscess associated with meningitis. Prevertebral space infection, vertebral osteomyelitis, and meningitis are reported to be associated with each other. When a patient presents with an altered mental status due to meningitis, signs and symptoms may be obscured and physicians may be unable to conduct detailed physical examinations or identify symptoms beyond neck stiffness. The threshold for imaging evaluation may need to be lowered for patients at high risk for prevertebral abscess or vertebral osteomyelitis. Physicians need to recognize this clinical entity, as prompt referral to specialists in head and neck surgery is essential for timely drainage.

Keywords: Meningitis; Neck stiffness; Prevertebral space infection; Vertebral osteomyelitis.

Publication types

Case Reports