A 50-year-old Hindu man from northern India presented with pain in his neck and restriction of neck movements of two months duration. The pain was not radiating to any other part, was present throughout the day and was aggravated during the night and after activity. He had no history of any traumatic episode. Our patient was experiencing little relief with analgesics. The pain was not associated with fever; he had no weakness in any of his limbs, nor difficulty in speech or deglutition. On examination, he had tenderness over the spinous processes of the upper half of his cervical spine along with spasm of his neck muscles. There was no deformity or gibbus. Our patient had gross restriction of motion of his cervical spine in all directions. He had no palpable lymph nodes in his neck. On neurological examination, there was no deficit in any limb and his tendon reflexes were normal. He had no other systemic illness. Laboratory investigations showed little abnormality other than an increased erythrocyte sedimentation rate (54 mm in the first hour). A lateral view of plain radiographs showed a fracture of the body of his second cervical (C2) vertebra with mild displacement of the fractured anterior body fragment. The odontoid process appeared to be in normal alignment with his C1 vertebra. There was also a significantly increased prevertebral soft tissue shadow anterior to the C1, C2 and C3 vertebral region, which indicates the presence of a retropharyngeal abscess. A computed tomography scan showed fragmentation of his C2 vertebral body and the anterior fragment lying separate from the parent bone. Posterior elements were found to be normal. MRI clearly depicted the extent of vertebral involvement in T1-weighted, T2-weighted and fat suppression sequences. The destruction and expansion of the C2 vertebral body was seen along with significant pre- and paravertebral collection. This appeared hypointense in T1-weighted and hyperintense on T2-weighted images. The soft tissue mass was seen compressing the airway anteriorly and was causing slight indentation of the thecal sac posteriorly. However, the cord appeared normal on signal intensity. His C2 and C3 vertebral bodies appeared hyperintense on fat suppression images, suggesting extensive bone marrow edema. His cervical intervertebral discs appeared degenerated at various levels but otherwise appeared intact. Transoral fine needle aspiration cytology of the lesion yielded caseous material on cytology but did not show any acid-fast bacilli. Our patient was given antitubercular treatment with a four-drug regimen (rifampicin, isoniazid, ethambutol, pyrazinamide) for two months followed by a two-drug regimen (rifampicin, isoniazid) for a period of four months. His cervical spine was protected by a Philadelphia collar. On follow-up radiographs, the fracture in his C2 vertebra was found to be united by the end of 16 weeks and the prevertebral soft tissue shadow returned to its normal limits. The pain and stiffness in his neck also improved significantly following treatment, although some terminal restriction of motion remained even at the end of 25 months follow-up.