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A patient in his 30s, who had arrived from Guinea-Bissau nine months earlier, presented to the emergency department with recent onset of odynophagia, dyspnoea, and dysphonia on a background of a posterior neck pain for the past six months. On physical examination, the patient exhibited inspiratory stridor, a bulge in the posterior pharyngeal wall extending to the right piriform sinus, and limited neck mobility. Neurological examination was unremarkable. A computed tomography scan of the neck showed a retropharyngeal abscess and osteolysis of the cervical and thoracic vertebral bodies. Magnetic resonance imaging excluded spinal cord compression (fig 1).