A 77-year-old male was hospitalized with a 6-day history of severe
posterior cervical pain and
headache. An initial lumbar puncture revealed polymorphonuclear
pleocytosis indicating pyogenic
meningitis. The blood and throat cultures on admission were positive for Staphylococcus aureus. A combination of
ceftriaxone and ABPC, both of which were sensitive to the pathogen, were intravenously administered for one month, by which he responded well as to the
meningitis. However, he was found to have persistent
neck pain, and wasting and weakness of the shoulder girdles, which were associated with
polyneuropathy-like sensory loss. Neuroimaging studies disclosed a partial destruction of the odontoid process, subluxation of the atlantoaxial joint, MRI evidence of an inflammatory pseudomass formation dorsal to the odontoid process and an increased uptake of
radionuclide on bone scanning, all of which were indicative of osteomyelitic processes at the region of the axis; i.e., the
meningitis was thought to be secondary to
osteomyelitis of the odontoid process and hence the foramen magnum syndrome characteristic to this particular case was explained by the compression of the cervicomedullary junction due to the pseudomass. To our knowledge, this is the first case of primary odontoid
osteomyelitis to be reported in Japan.