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56 Acquired torticollis in a toddler- a rare diagnosis

Kaninde, Abhidhamma ; Rasheed, S ; Aslam, M

Archives of disease in childhood, 2021-10, Vol.106 (Suppl 2), p.A23-A24 [Periódico revisado por pares]

London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health

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  • Título:
    56 Acquired torticollis in a toddler- a rare diagnosis
  • Autor: Kaninde, Abhidhamma ; Rasheed, S ; Aslam, M
  • Assuntos: Abstracts ; Antibiotics ; Benzylpenicillin ; Computed tomography ; Cough ; Diagnosis ; Encephalomyelitis ; Etiology ; Fever ; Hyperemia ; Immunization ; Magnetic resonance imaging ; Medical diagnosis ; Meningitis ; Mucocutaneous lymph node syndrome ; Mumps ; Neck ; Patients ; Pediatrics ; Serology ; Spine (cervical) ; Torticollis ; Trauma
  • É parte de: Archives of disease in childhood, 2021-10, Vol.106 (Suppl 2), p.A23-A24
  • Notas: 10th Europaediatrics Congress, Zagreb, Croatia, 7–9 October 2021
    General Pediatrics
  • Descrição: IntroductionAcquired torticollis although uncommon but is an important presentation in paediatric setting. One should be very thorough and sucpicious while evaluating these patients. If the torticolliis is non- traumatic it suggests more serious pathology. In our case, neck swelling with fever was pointing towards infective etiology but persistent symptoms made us evaluate this case thoroughly to come up with diagnosis of atlanto axial dislocation confirming Grisel syndrome.Case SummaryWe present a case of a 2-year girl old who presented with history of fever, on and off neck stiffness and reduced oral intake for three days. She was given IM benzylpenicillin in the community considering possibility of meningitis.There were similar two distinct episodes in past where she developed cough, fever and transient difficulty in moving her neck. Both times she recovered fully without any residual symptoms.Her systemic review was unremarkable. She was normally fit & healthy with up to date immunizations.On examination, she had head tilt to the right side with diffuse swelling in left mandibular region. There were no rashes. T-37.4°C. Other examination were unremarkable.Apart from marrginally elevated CRP her septic screen was normal. Her persistent symptoms despite intravennous antibiotics prompted CT scan of her neck showing rotatory sublaxation of Atlantoaxial joint suggesting Griesel Syndrome while her MRI brain was reported as normal ruling out space occupying lesion.A week later her serology confirmed the diagnosis of mumps despite of having previous immunization.She was transferred to tertiary care hospital where a ASPEN neck collar was inserted under sedation with good recovery.DiscussionWhile approaching patients with acquired torticollis one should be mindful of wide range of diffrentials like simple trauma to potential space occupying lesion. Blankstein et el describes 61% cases of torticollis being non traumatic in this age group. Underlying pathology could be very diverse ranging from ADEM to Kawasaki disease.In our case, as patient presented with fever and diffuse neck swelling, we considered only infective etiology initially. But with her persistent symptoms we expanded our diffrentials and investigated accordingly confirming Griesel syndrome secondary to Mumps. Park et el descibes how pharyngovertebral vein act as an septic channel leading to atlanto axial hyperemia and inturn present as torticollis.ConclusionOur case is learning lesson to consider possibility of Mumps as diffrential diagnosis irrespetive of previous immunization status and also to remember comorbidities associated with infective patology like Griesel syndrome.
  • Editor: London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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