Case 34-2008 -- A 58-Year-Old Woman with Neck Pain and Fever

doi:10.1056/NEJMcpc0806980

Volume 359:1942-1949		October 30, 2008		Number 18

Case 34-2008 — A 58-Year-Old Woman with Neck Pain and Fever

Julie L. Gerberding, M.D., M.P.H., Javier M. Romero, M.D., and Mary Jane Ferraro, Ph.D., M.P.H.

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Presentation of Case

Dr. Mary Pisculli (Infectious Disease): A 58-year-old womanwas transferred to this hospital because of severe right-sidedneck pain, fever, and abnormal findings on cervical magneticresonance imaging (MRI).

Two to 3 weeks before admission, she noted swelling in the rightanterior portion of the neck, which she thought was an enlargedlymph node; the swelling was associated with pain in her neck.The pain increased in severity over a period of several daysand began to radiate intermittently to the right shoulder. Sheunderwent an acupressure massage, without relief, and the nextday tingling developed in all fingers but . . . [Full Text of this Article]

Differential Diagnosis

Spinal Epidural Abscess

Tuberculosis

Brucellosis

Summary

Clinical Diagnosis

Dr. Julie L. Gerberding's Diagnosis

Pathological Discussion

Determining the Source of the Infection

Lessons Learned by the Laboratory

Anatomical Diagnosis

Source Information

From the Centers for Disease Control and Prevention, Atlanta (J.L.G.); the Department of Radiology (J.M.R.) and the Clinical Microbiology Laboratory and Department of Pathology (M.J.F.), Massachusetts General Hospital, Boston; and the Departments of Radiology (J.M.R.) and Pathology (M.J.F.), Harvard Medical School, Boston.