Medically treated deep neck abscess presenting with occipital headache and meningism

We report a 45-year-old man who presented with fever, acute occipital headache, and neck stiffness. He denied immunocompromised state such as diabetes, cancer or AIDS. Lumbar puncture showed normal cerebrospinal fluid findings in spite of laboratory parameters indicating inflammatory reaction. Magnetic resonance imaging of neck demonstrated wide spread enhancing mass of the deep neck space, leading to the final diagnosis of deep neck abscess. A long course of appropriate antibiotic administration finally resolved the inflammation and resulted in a good clinical outcome without surgical drainage. We postulated that deep neck abscess is an important differential diagnosis in a patient with meningism and medical treatment may be available for immunocompetent deep neck abscess.