Choosing to become a general practitioner.

of retropharyngeal abscess or bony destruction. Sputum was negative for acid-fast bacilli on microscopy and culture. The results of blood cultures were negative. No other organism was seen on microscopy or cultured from the fluid aspirated from the neck. Treatment with azathioprine was stopped and prednisolone was continued at a dose of 15 mg a day. Treatment with daily intramuscular streptomycin and oral rifampicin, isoniazid, and ethambutol was started. The swelling in the neck and the temperature gradually diminished over the first week in hospital. Two weeks after she was admitted to hospital a tablespoonful of pus was expressed from the neck; azathioprine 100 mg daily was reintroduced because of increasing joint stiffness. The patient was discharged receiving prednisolone, azathioprine, ethambutol, rifampicin, and isoniazid. Five months after admission she remained well, the neck swelling had settled, and her chest x-ray films showed improvement.