Medically treated paravertebral Brucella abscess presenting with acute torticollis: case report.
BACKGROUND
Atlantoaxial subluxation secondary to a paravertebral (retropharyngeal) abscess is a well known but rare event in children.


METHODS
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.
Simsek
Serkan
S
Neurosurgery Department, Ministry of Health, Diskapi Educational and Research Hospital, Ankara, Turkey.
Yigitkanli
Kazim
K
Kazanci
Atilla
A
Belen
Deniz
D
Bavbek
Murad
M
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D001915:Braces; D017347:Brucella melitensis / Q000276:immunology; D002006:Brucellosis / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D002648:Child; D006801:Humans; D004204:Joint Dislocations / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D008297:Male; D017703:Retropharyngeal Abscess / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012698:Serologic Tests; D013122:Spinal Diseases / Q000382:microbiology* / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D014103:Torticollis / Q000382:microbiology* / Q000503:physiopathology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents