Complications of intravenous drug abuse, such as subcutaneous abscess, joint infections, osteomyelitis, overdose, hepatitis, and infective endocarditis, account for an increasing number of admissions in accident and emergency departments throughout the UK.¹ Orthopaedic problems, such as soft tissue and joint infections, are responsible for at least 30% of these acute admissions. Intravenous drug users have always experienced considerable morbidity with increased susceptibility to such infections.

We present an unusual case of cervical osteomyelitis associated with intravenous drug abuse and advise that the emergency physician should have a high index of suspicion in this patient group as these infections present in a subclinical manner. We also propose that the mechanism of dissemination of bacteraemia in this case is probably via the external jugular vein to the spinal column.

CASE REPORT

A 43 year old white man presented to the accident and emergency department with increasing pain in his neck associated with tingling in both hands. He was a longstanding intravenous drug user (approximately 20 years), injecting in his groin, antecubital fossae, and, more recently, the external jugular veins.

Clinical examination revealed no skin changes, tenderness on active and passive neck movements, or …