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An 11 year old Pakistani boy presented with a four month history of dysphagia and weight loss of 10 kg, which followed a sore throat. Physical findings included diffuse swelling below the angle of the jaw on the left, stiffness of the neck, and wasting of the left side of the tongue with deviation to the left, on protrusion (fig 1). MRI (post-contrast stir sequence) showed an extensive cystic/solid mass in the retropharyngeal and prevertebral spaces, with possible extension to the base of skull (fig 2). Incision and drainage yielded non-offensive pus, which subsequently grew isoniazid resistant Mycobacterium tuberculosis.
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