Case presentation
A 51-year-old man, with no significant medical history, presented with a twenty-day history of inflammatory neck pain. Physical examination revealed a paravertebral muscle contracture and restricted neck movement. His body temperature was 38.7°C. Cardiac and neurological examinations were unremarkable. Laboratory examinations showed a white blood cell count of 13,700/mm3.
He had an elevated erythrocyte sedimentation rate and C-reactive protein level of 80 mm/h and 185 mg/L respectively. Urine analysis, blood cultures, and tuberculosis skin test were negative.
Spine MRI showed synovitis of atlanto-odontoid joint and an anterior epidural collection (figure 1 ). There was thrombosis of the right sigmoid sinus and the internal jugular venous (figure 2 ). Transthoracic echocardiography was unremarkable.
CT-guided percutaneous drainage of the epidural collection was unsuccessful.
The patient underwent a twelve-week course of probabilistic anti-staphylococcal antibiotic treatment associated with immobilization of the cervical spine. Vitamin k antagonist was also prescribed for 6 months. MRI performed one month after the start of treatment showed a disappearance of the epidural collection (figure 3 ). Inflammatory markers have decreased and remained within normal limits.