Medically treated paravertebral Brucella abscess presenting with acute torticollis: case report

Surg Neurol. 2007 Feb;67(2):207-10. doi: 10.1016/j.surneu.2006.06.061.

Abstract

Background: Atlantoaxial subluxation secondary to a paravertebral (retropharyngeal) abscess is a well known but rare event in children.

Case description: The authors describe the clinical and radiologic findings of a case of 6-year-old child who presented with acute torticollis (duration, 4 days). Type 2 atlantoaxial rotatory fixation and upper cervical paravertebral (retropharyngeal) abscess were diagnosed on radiologic examination. Laboratory test results showed positive agglutination titer for Brucella melitensis, in the rate of 1/640 dilution. This is the first reported case of Brucella-related atlantoaxial subluxation in a child in the pediatric literature. The patient was treated successfully with anti-inflammatory drugs, Brucella-specific antibiotic regimen, and Philadelphia collar application. Possibly, effusion of the atlantoaxial joint, due to Brucella infection, led to the laxity of the ligaments and contributed to subluxation.

Conclusions: Brucella abscess should be kept in mind for the differential diagnosis of retropharyngeal mass, and the torticollis may be the only presenting sign. The authors recommend a trial of medical treatment with adequate dosages for a reasonable length of time and immobilization before considering surgical intervention for the spinal paravertebral Brucella abscess and related atlantoaxial subluxation.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Axis, Cervical Vertebra / diagnostic imaging
  • Axis, Cervical Vertebra / microbiology
  • Axis, Cervical Vertebra / pathology
  • Braces
  • Brucella melitensis / immunology
  • Brucellosis / complications*
  • Brucellosis / diagnosis
  • Brucellosis / physiopathology
  • Cervical Atlas / diagnostic imaging
  • Cervical Atlas / microbiology
  • Cervical Atlas / pathology
  • Child
  • Humans
  • Joint Dislocations / microbiology
  • Joint Dislocations / pathology
  • Joint Dislocations / physiopathology
  • Male
  • Retropharyngeal Abscess / complications*
  • Retropharyngeal Abscess / diagnosis
  • Retropharyngeal Abscess / physiopathology
  • Serologic Tests
  • Spinal Diseases / microbiology*
  • Spinal Diseases / pathology
  • Spinal Diseases / physiopathology
  • Tomography, X-Ray Computed
  • Torticollis / microbiology*
  • Torticollis / physiopathology
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents