Osteomyelitis of the odontoid process with associated retropharyngeal abscess: A case report

Abstract Objective To report an interesting and informative case of a unique clinical entity. Methods Individual case report. Results We report a case of a 58-year-old female who presented with ten days of intractable neck pain and acutely worsening mental status. Her past medical history included type 2 diabetes mellitus, hypertension, hyperlipidemia and hypothyroidism. Initial laboratory workup revealed leukocytosis, and elevated CRP and ESR. CT scan of the cervical spine showed prominence of the retropharyngeal soft tissues. A subsequent MRI showed enhancing, lytic changes of the odontoid process with surrounding edema and soft tissue inflammatory changes, as well as a discrete fluid collection in the left anterior prevertebral space. Due to worsening airway compromise, the patient was intubated and taken to the operating room for evacuation of the retropharyngeal fluid collection. Intraoperatively, there was noted to be a small defect in the posterior nasopharyngeal mucosa, with active purulent drainage. Following decompression of the retropharyngeal abscess, the patient slowly improved, and remained on an extended course of IV antibiotics before being discharged to a rehab facility. Conclusion Pyogenic vertebral osteomyelitis rarely occurs in the cervical spine, and only a handful of reports have described involvement of the odontoid process. Diagnosis of this rare entity is often delayed due to the vague presenting symptoms and location deep within the soft tissues of the neck. Although retropharyngeal abscess most commonly occurs as a complication of an upper respiratory tract infection, this case demonstrates the possibility of an underlying vertebral infection.