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Case report
Delayed diagnosis of an upper cervical epidural abscess masked due to crowned dens syndrome
  1. Hiroshi Sugimoto1,
  2. Takuji Hayashi2,
  3. Shun Nakadomari3 and
  4. Keisuke Sugimoto1
  1. 1Department of Respiratory Medicine, Kobe Red Cross Hospital, Kobe, Hyogo, Japan
  2. 2Department of Otolaryngology, Kobe Red Cross Hospital, Kobe, Hyogo, Japan
  3. 3Department of Radiology, Kobe Red Cross Hospital, Kobe, Hyogo, Japan
  1. Correspondence to Dr Hiroshi Sugimoto; dr.sugimoto{at}


An 87-year-old Japanese man presented to our hospital with a 5-day history of fever and neck pain. On physical examination, his stiff neck indicated restricted movement, especially on rotation. CT of the head revealed calcification of the atlantoaxial joint consistent with crowned dens syndrome, and celecoxib was started. Four days later, he returned to our emergency department as his neck pain and fever had not improved. Pneumonia and a urinary tract infection were suspected. The day following admission, blood culture results were positive for methicillin-resistant Staphylococcus aureus. A contrast-enhanced CT revealed an upper cervical epidural abscess at the level of C1–C2. He was discharged following 8 weeks of antibiotic treatment.

  • infectious diseases
  • medical management
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  • Contributors HS drafted the manuscript. TH, SN, and KS revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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