Pyogenic cervical osteomyelitis presenting as a massive prevertebral abscess in a patient with rheumatoid arthritis.

Pre-existing rheumatoid arthritis appeared to have masked the diagnosis and contributed to a succession of hazardous events in a 58-year-old man with pyogenic cervical osteomyelitis. A massive prevertebral abscess and near asphyxiation finally led to the diagnosis of an indolent Staphylococcus aureus infection in a course marked by antecedent staphylococcal sepsis, a series of dangerous cervical spine chiropractic manipulations in the presence of advanced bony destruction, and, ultimately, cervical spine bony collapse and gibbus formation. The absence of myelopathy despite long-standing progressive advanced destruction is noteworthy. The roentgenologic documentation of this progression was unique. This appears to be the first fully documented case of cervical spine osteomyelitis presenting as a prevertebral abscess in a patient with rheumatoid arthritis.