Disclosures: Zachary Belford, DO: Nothing to disclose

Case Description: A 60-year-old male was referred for consultation with right-sided headache and neck pain for 1 month. He had presented to the emergency department 1 month prior with severe headache, cervical spasms, and radiating pain down his neck and right upper extremity. He received oxycodone, cyclobenzaprine, and acetaminophen for a presumed diagnosis of cervical radiculopathy. A neck CT showed severe C6-C7 and moderately severe C5-C6 degenerative disc disease. Ultimately, CT head showed bilateral mastoid inflammatory disease and intracranial atherosclerosis. The patient was subsequently admitted to the hospital for treatment of mastoiditis with broad-spectrum antibiotics and intravenous corticosteroids.

Setting: General rehabilitation outpatient clinic.

Patient: 60-year-old male with persistent headache and neck pain.

Assessment/Results: The patient recovered and was discharged home. At the time of physiatry consultation about one month later, his right-sided headache and neck pain were improved but still interfering with his daily activities. The differential diagnosis included facet arthropathy and residual pain from mastoiditis. Physical therapy was prescribed with reported improvement in pain.

Discussion: Physiatrists are often consulted on patients with pain that is presumed to be musculoskeletal in nature. Common among these presentations is head and neck pain, which carries a broad differential diagnosis. One must consider spinal pathologies such as cervical radiculopathy, facet arthropathy, and disc disease. Before proceeding, it is critical to rule out infectious etiologies such as mastoiditis and meningitis. Physicians should be aware that the pain referral patterns of mastoiditis and otitis media or externa overlap with those of cervical facet joint pain.

Conclusion: Physiatrists encounter numerous cases of head and neck pain in daily practice. Often the source of pain is attributed to musculoskeletal causes, potentially leading to a missed diagnosis of infection due to mastoiditis or otitis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/masquerading-mastoiditis-a-case-report-of-musculoskeletal-pain-masking-an-infectious-etiology/