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Image challenge
Man with neck pain
  1. Chun-I Liu1,
  2. Yuan-Pin Hsu2,3,
  3. Chun-Lin Kuo2,4
  1. 1 Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  2. 2 Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  3. 3 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  4. 4 Department of Emergency Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Dr Chun-Lin Kuo, Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; wfvghk{at}gmail.com

https://doi.org/10.1136/emermed-2022-212578

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    Clinical introduction

    A 43-year-old man without medical history presented to ED with a 10-day history of neck pain. At triage, his body temperature was 39.6oC and blood pressure was 95/55 mm Hg. On physical examination, there was posterior neck swelling and stiffness without neurological deficit. Blood tests revealed white cell count of 35 930/mm3 and C reactive protein of 29.6 mg/dL. Neck plain radiography was performed (figure 1).

    Figure 1

    Question figure.

    Question

    What is the most likely diagnosis?

    1. Cervical spine fracture

    2. Oesophageal rupture

    3. Meningitis

    4. Necrotising fasciitis

    Answer: D. Necrotising fasciitis (NF)

    The plain film showed multiple heterogeneous radiolucent lesions (figure 2, arrow) along the posterior …

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    Footnotes

    • Contributors C-IL reviewed the case and wrote the manuscript. Y-PH contributed to manuscript review. C-LK contributed to the case and manuscript revision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.