title: Multiple abscesses with osteomyelitis and destruction of both the atlas and the axis in a 4-week-old infant.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report an unusual case of a 4-week-old infant with multiple abscesses, which propagated to the cervical region and destroyed the C1-C2 vertebrae.
  
  
  BACKGROUND
  Cervical vertebral osteomyelitis involving the atlas and axis in childhood is distinctly unusual, which may lead to the rapid destruction of the vertebral body. Propagation of a retropharyngeal abscess is the major cause of cervical vertebral osteomyelitis. Only a limited number of infant case reports are published, and no case of osteomyelitis with the destruction of both the atlas and the dens axis has been reported previously.
  
  
  METHODS
  A 1-month-old infant with multiple craniospinal and thoracic abscesses was surgically treated. Therapy was completed with antibiotics and immobilization. Follow-up was carried out with magnetic resonance imaging, computed tomographic scans, and functional radiographical diagnostics.
  
  
  RESULTS
  The retropharyngeal and thoracic abscesses were surgically removed. The infant was placed in a custom-made fixation device for 8 weeks. Two months later, follow-up functional examination revealed no significant instability of the cervical spine. During a 3-year-long follow-up period, no signs of neurological impairment were observed, neck movements were limited but painless. It is assumed that the remnants of the bony elements of C1-C2 vertebrae and the massive interconnecting postinflammatory scar tissue make some degree of neck movements possible.
  
  
  CONCLUSIONS
  C1-C2 osteomyelitis is a very rare entity even in children. There is limited experience with treatment, but immobilization of the neck, surgical debridement, drainage, and antibiotic treatment can be recommended. Close follow-up is required to check the reconstitution of affected bones and ligaments, any development of instability, and the necessity of surgical stabilization.
authors.affiliation: *National Institute of Neurosurgery, Budapest, Hungary; and †Department of Neurosurgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Papp
authors.forename: Gábor
authors.initials: G
authors.lastname: Czigléczki
authors.forename: Péter
authors.initials: P
authors.lastname: Banczerowski
mesh_terms: D001368:Axis, Cervical Vertebra / Q000473:pathology*; D001270:Cervical Atlas / Q000473:pathology*; D020802:Epidural Abscess / Q000150:complications / Q000175:diagnosis*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis*