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Reminder of important clinical lesson
Osteoradionecrosis of the cervical spine complicated by pneumocephalus and meningitis in a nasopharyngeal cancer patient radically treated with radiotherapy 11 years ago
  1. Shimin Jasmine Chung1,
  2. Lim Wan-Teck2,
  3. Seng Choe Tham3,
  4. Iain B H Tan2,
  5. Michael L C Wang4,
  6. James B Khoo3
  1. 1
    Singapore General Hospital, Singhealth Services, Medical Oncology, National Cancer Centre, 11 Hospital Drive, Singapore, 169610, Singapore
  2. 2
    National Cancer Centre, Medical Oncology, 11 Hospital Drive, Singapore, 169610, Singapore
  3. 3
    National Cancer Centre, Oncologic Imaging, 11 Hospital Drive, Singapore, 169610, Singapore
  4. 4
    National Cancer Centre, Radiation Oncology, 11 Hospital Drive, Singapore, 169610, Singapore
  1. Shimin Jasmine Chung, jas_chung{at}


Superimposed infection of osteoradionecrotic cervical spine with cranial extension is difficult to treat and potentially fatal. This report describes the case of a middle-aged Chinese man 11 years post radical radiotherapy for nasopharyngeal cancer with no evidence of disease presenting initially with neck pain secondary to cervical osteoradionecrosis. He was re-admitted a month later with aspiration pneumonia associated with Streptococcus milleri bacteraemia, complicated by septic shock. The last re-admission was 2 months later with fever, expressive dysphasia and right upper motor neuron signs. There was interval increase of dental and peridental soft tissue mass, interval widening of atlantodental distance on MRI cervical spine associated with pneumocephalus, meningeal enhancement and pre-pontine soft tissue mass on CT brain consistent with infected osteoradionecrotic cervical spine complicated by cranial extension. The patient also had concomitant bilateral pneumonia and subsequently passed away from fulminant sepsis.

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  • Competing interests: none.

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