Acquired Torticollis as the Initial and Only Finding in Nasopharyngeal Carcinoma: A Case Report

Torticollis or involuntarily twisted neck is considered to be a sign rather than a condition. Some of the main causes of torticollis are trauma, medication side-effects, infectious and inflammatory processes, and head and neck tumors.A 26-year-old female patient presented with acute acquired torticollis for four months, and the conditions had complicated due to constitutional symptoms, such as weight loss, sweating, and decreased appetite, eventually leading to trismus. Neck CT-scan showed bilateral lymph node enlargements, soft tissue stranding, right-sided asymmetry of the fossa of Rosenmüller (pharyngeal recess), and a heterogeneous enhancing mass on the nasopharynx roof with left extension and bilateral pressure on the Eustachian tube. The biopsy of the mass indicated the infiltration of atypical epithelial cells with marked nuclear atypia in small solid nests within the lymphoid tissue of the nasopharynx, which corresponded to nasopharyngeal carcinoma. However, the patient had no risk factors for nasopharyngeal carcinoma. This study highlighted the importance of a complete work-up for the underlying tumors in the head and neck in the patients presenting with the only finding of torticollis.