Article in Japanese

Concomitant atlantoaxial rotatory fixation from right axillary lymph node abscess

Kenichiro TAKAHASHI¹⁾, Yuri TAKAHASHI¹⁾, Yoko SHIDA¹⁾, Nahoko YASUDA¹⁾, Yoko SUZUKI^1,2), Shigetaka SUGIHARA¹⁾

A 7-year-old previously healthy girl was hospitalized with fever, axillary pain, and torticollis on the eighth day of illness. The illness was diagnosed as a right axillary lymph node abscess with enhanced magnetic resonance imaging. Regarding torticollis, no apparent dislocation was detected. The abscess was difficult to puncture and ceftriaxone treatment was initiated, leading to defervescence of the fever after a few days. The abscess gradually reduced in size. The patient was treated with antibiotics for 3 weeks and the abscess resolved. However, torticollis persisted, and cervical computed tomography (CT) was performed on the 15th day of illness. After diagnosis of atlantoaxial rotatory fixation (AARF), Glisson traction was initiated. On the 29th day of illness, torticollis improved according to cervical CT. No pathogens were observed in the culture, but an anti-streptolysin O (ASO) level of >1,500 IU/mL was considered to be markedly high, and Streptococcus pyogenes was presumed to be the causative pathogen (19th day of illness). This case demonstrates the usefulness of serum antibody titer in cases where puncture is difficult, such as axillary lymph node abscess, and the importance to diagnose AARF and to start treatment promptly.

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1) Departments of Pediatrics, Tokyo Women's Medical University Medical Center East
2) Department of Health and Nutrition, Wayo Women's University

Key words	axillary lymph node abscess, atlantoaxial rotatory fixation, Streptococcus pyogenes
Received	December 10, 2019
Accepted	March 5, 2020

32 (2)：134─140,2020