Osteomyelitis of the Odontoid Process Associated With Meningitis and Retropharyngeal Abscess. Case Report.

Abstract

A 52-year-old man complaining of headache and nuchal pain was treated initially under a diagnosis of bacterial meningitis. The meningitis resisted antibiotic therapy, and one week later was complicated by a ruptured retropharyngeal abscess, which led to the correct diagnosis of osteomyelitis of the odontoid process of the axis. His neck was immobilized in a high neck collar and the retropharyngeal abscess was treated by repeated drainage and irrigation. A long course of antibiotic administration finally resolved the infection. Osteomyelitis of the odontoid process is rare and presents with peculiar signs and symptoms. Careful consideration of the differential diagnosis is needed for the early detection of this potentially serious condition.

Imaging of nasopharyngeal cysts and bursae

“…In the event of a prevertebral abscess, a locoregional infection must be searched for in the odontoid process or the petrous apex [45,46]. In the case of a retropharyngeal abscess, a rhino-pharyngitis or a local traumatism is a possible etiology [33,47].…”

Septic Arthritis of the Atlantoaxial Joint

“…1 Isolated involvement of the atlantoaxial segment has rarely been documented in the English literature. [2][3][4][5][6][7][8][9][10][11][12]13,18,19 In all cases, the odontoid processes were mainly affected with osteomyelitis and in some patients subsequent dislocation of the atlantoaxial joint 3,12 or formation of epidural abscess with progressive neurologic deficits was noted. 10,13,20 Furthermore, septic arthritis of the facet joints is also an uncommon clinical entity.…”

“…6,[8][9][10]20 In case of early diagnosis of infectious foci in the atlantoaxial region, conservative treatment with antibiotics and immobilization is likely to be sufficient. Thus, the success of treatment of infectious lesions in the upper cervical spine region is greatly dependent on the early diagnosis and initiation of therapy.…”

“…Most epidural abscesses in the upper cervical spine are accompanied by osteomyelitis confined to the odontoid process. [2][3][4][5][6][7][8][9][10][11][12][13] Therefore, epidural abscess after septic arthritis of the atlantoaxial joint has the least common incidence. Septic arthritis of the facet joint itself is an uncommon clinical entity, and most reported cases have been in the lumbar region.…”

Complete Osteolysis of the Dens With Atlantoaxial Luxation Caused by Infection With Staphylococcus Aureus

“…7,8,10,13 Infections of the dens caused by purulent bacteria are extremely rare compared with those caused by tuberculosis. [22][23][24][25][26][27][28][29][30][31][32][33][34] Among these rare cases only two were reported in which operative procedures for stabilization were necessary, but the degree of damage was well below the damage seen in the case presented and neither lead to a complete osteolysis of the dens nor to spontaneous atlantoaxial luxation. The others could be treated conservatively with immobilization, antibiotic therapy and, in some cases, drainage of the pus.…”