Acute neck pain caused by septic arthritis of the lateral atlantoaxial joint with subluxation: a case report

Abstract

IntroductionCrystal-induced arthritis of the lateral atlantoaxial joint may be intimately involved in acute neck pain in the elderly. Patients typically have a good prognosis, and symptoms usually subside within a few weeks. On the other hand, septic arthritis of the lateral atlantoaxial joint requires early diagnosis and antibiotic treatment. Diagnostic delay is a risk factor for an unfavorable outcome of vertebral osteomyelitis. Even though septic arthritis of the lateral atlantoaxial joint is a very rare clinical entity, it is important to differentiate septic arthritis from crystal-induced arthritis.Case presentationA 53-year-old Japanese man presented with neck pain, stiffness, and loss of power of his left upper extremity which started 20 days before his visit to our hospital. A physical examination revealed a limited range of motion of his neck, with rotation being especially very restricted. Atlantoaxial subluxation was seen on plain radiography of his cervical spine. During puncture of the lateral atlantoaxial joint, clear yellow fluid was collected. Cultures later grew methicillin-sensitive Staphylococcus aureus. He was diagnosed with septic arthritis of the lateral atlantoaxial joint with atlantoaxial subluxation. After diagnosis, intravenous administration of antibiotics was begun. The atlantoaxial region was stabilized with the Brooks procedure. Plain radiography showed complete bone union 8 months after operation. At a follow-up evaluation 7 years after initial onset, he had complete relief of neck pain, and there were no neurological abnormalities.ConclusionsA patient with septic arthritis of the lateral atlantoaxial joint with subluxation presenting with acute neck pain was successfully treated with antibiotics and fusion surgery. In patients with persistent neck pain, septic arthritis of the lateral atlantoaxial joint should be considered and further examinations performed.

Cervical facet joint septic arthritis: a real pain in the neck

“…However, this case illustrates how potentially fatal this diagnosis is, with the patient experiencing severe sepsis and requiring respiratory and renal support. Previous cases of cervical septic arthritis report a more insidious course, with symptoms of neck pain progressing over months before requiring intervention 4. In contrast, in this case the patient only experienced symptoms for 2 days, with rapid progression to septic shock and multiorgan failure.…”

“…Cervical facet joint arthritis is even rarer, with only a small number of reported cases worldwide. There are 10 previous cases of septic arthritis affecting the cervical spine, involving the atlanto-axial facet joints (five cases)4 and the subaxial cervical facet joints (five cases) 5–8. Here, we present a near fatal case of subaxial cervical facet joint septic arthritis.…”

Septic arthritis of the cervical facets: Unusual cause of neck pain

“…A common site of septic arthritis of the facet joint is the lumbar spine, which is reported in approximately 90% cases . Only a few cases of cervical facet infection similar to this case have been reported . In those cases, unilateral neck pain was the initial presentation, with rapid symptom progression.…”

Calcium pyrophosphate dihydrate crystal deposition disease and MRSA septic arthritis of the atlantoaxial joint in a patient with Tourette syndrome

“…Calcium pyrophosphate dihydrate crystal deposition disease or pseudogout is characterised by deposition of CPPD crystals in hyaline cartilage and fibrocartilage. Like septic arthritis, pseudogout of the cervical vertebral joints would present with acute posterior neck pain, fever and neck stiffness, making differentiating the two fairly difficult without joint aspiration 10. One retrospective study from 2013 identified the prevalence of crystal disease in joint fluid of patients with previously diagnosed arthritis of those joints.…”