Deep neck infection as the presenting feature of occult papillary thyroid carcinoma has not been reported. Here, we report a 67-year-old woman with deep neck infection as the initial manifestation of occult papillary thyroid carcinoma, and the fi nal diagnosis is papillary thyroid carcinoma with neck metastasis. We hope to emphasize occult papillary thyroid carcinoma should be further differential diagnosed when dealing with deep neck infection. A complete examination of head and neck in such patients must include thyroid gland.