A 43-year-old man is admitted to hospital for a 4-day history of severe neck pain and fever. He has hepatitis C and HIV. Temperature is 103 F. Cardiac examination shows a 3/6 holosystolic murmur loudest at the apex. The neck is tender over the cervical spine. There is no warmth or erythema. Neurologic examination is unremarkable. A chest-xray shows no abnormalities. Cervical spine x-ray shows destructive alterations in the C4 through C6 vertebrae. Which of the following is the most likely mechanism of this patient’s neck pain?
Contiguous spread of organism from adjacent soft tissues
Direct innoculation of cervical soft tissues
Granulomatous inflammation
Hematogenous dissemination
Reactivation of latent organism
