Neck pain is a common presentation to the emergency department. We report a case of cervical tuberculous spondylitis in an old lady with neck pain. She re-attended the emergency department because of progressive nocturnal pain and stiffness. X-ray of the cervical spine showed blurred endplate and prevertebral soft tissue swelling. CT cervical spine showed evidence of infective discitis. Surgical intervention and anti-tuberculosis therapy were given. The patient became bed-ridden and died of pneumonia two months later. Alarming clinical features and serial assessment of X-ray changes would help to look for potentially fatal differential diagnoses of neck pain.
