Pyogenic spondylitis is one of the destructive infectious diseases of the spinal cord and bones. This disease is common after radiation therapy for head and neck malignancy, but the case of pyogenic spondylitis due to pharyngeal mucosa perforation after prolonged gastric tube placement was not reported. We present a case of a 70-year-old woman who suffered cervical pyogenic spondylitis after radiation and surgery for hypopharyngeal cancer about 30 years ago. Although the initial therapy had been successful, oropharyngeal cancer was diagnosed and tumor resection was performed. Two weeks after surgery, she suffered from cervical abscess and underwent incision and drainage from the submandibular space. After the second surgery, she complained of paresis of the upper limb and cervical pain. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed C5-6 pyogenic spondylitis and the patient underwent another surgery by an orthopedic surgeon. The perforation of the pharyngeal mucosa was detected during the operation and this was considered the cause of the cervical abscess. Gastric tube has been placed for 3 months and a half due to nutritional supplementation and pressure reduction inside the throat. While examining her previous CT scans, Forestier disease was identified. The front of the cervical spine and the gastric tube had been in contact for three and a half months due to Forestier disease, which led to the perforation of the pharyngeal mucosa. Streptococcus anginosus, which is intraoral indigenous bacteria, was detected in bacterial examination. This is the first report showing that prolonged gastric tube insertion is a risk for cervical abscess in head and neck malignancy with Forestier disease after radiation at the same site. The early introduction of gastric or intestinal fistula is one option in patients with Forestier disease undergoing treatment for head and neck malignancy.
