Unusual cause of neck pain

Description

A 69-year-old man with hyperlipidaemia presented to the emergency department with a 4-day history of new onset pain in the neck. The pain was severe (rated 9/10 in severity), constant, localised to the base of the skull and was associated with significant restriction of neck motion; any movements resulted in dramatic worsening of the pain. He also reported subjective fevers at home. He did not report trauma, photophobia, phonophobia, nausea, vomiting, insect bites, visual disturbances, trouble swallowing or speaking, jaw claudication or morning stiffness. There were no sick contacts. He did not have pain at any other sites. He had tried some topical diclofenac gel for the past 2 days without much relief. His only scheduled medication was atorvastatin.

On physical examination, his temperature was 38.1°C, blood pressure was 128/82 mm Hg, heart rate was 82/min and respiratory rate was 14/min. He was visibly trying not to move...

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