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

ŞİMŞEK S., Yigitkanli K., Kazanci A., Belen D., Bavbek M.

Surgical Neurology, vol.67, no.2, pp.207-210, 2007 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 67 Issue: 2
  • Publication Date: 2007
  • Doi Number: 10.1016/j.surneu.2006.06.061
  • Journal Name: Surgical Neurology
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.207-210
  • Keywords: Brucella, atlantoaxial rotatory subluxation (AARS), cervical spine, paravertebral abscess, retropharyngeal abscess, torticollis, AXIAL ROTATORY FIXATION, ATLANTOAXIAL SUBLUXATION, SPONDYLITIS, COMPLICATIONS, SECONDARY, CHILDREN, ADULT, SPINE
  • Lokman Hekim University Affiliated: No


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. © 2007 Elsevier Inc. All rights reserved.