Rare cause of cervical osteoarthritis

A healthy 2-year-old child was referred to the paediatric emergencydepartment for febrile torticollis with 1 cm painful cervical lymph nodes. Blood tests showed 20.8 mg/L C reactive protein and an acute Epstein-Barr virus infection. The persistence of torticollis despite a regular intake of both paracetamol andibuprofen for 2 weeks suggested another aetiology. A CT scan associated with MRI showed an inflammatory process at the C1–C2 vertebrae, and Kingella kingae-specific PCRwas positive on biopsy. Cefamandole (150 mg/kg/day) was given intravenously for 7 days, followed by oral amoxicillin (100 mg/kg/day) for 15 days. Clinical and radiological follow-up demonstrated the absence of bone sequelae, and the child recovered well.Acquired torticollis is a common presentation of variouspaediatric diseases, including muscle contraction, trauma, infection or malignancy. The oropharyngeal carriage of K. kingae is frequent in young children. Viral infection may promotethe diffusion of K. kingae into the oropharyngeal mucosa and its secondary dissemination to any distant organ via the bloodstream.The most frequent clinical manifestation of invasiveK. kingae infection is osteoarticular infection (OAI), with clinical,biological and radiological signs that are commonly mildto moderate. Establishing the cause of cervical arthritis may be affected by difficulties in obtaining samples for culture. Thus, afinding of K. kingae-positive PCR from an oropharyngeal swabmight be helpful for young children suspected of OAI, avoiding the need to perform an invasive investigation.MRI should be performed in young children with unexplained febrile torticollis persisting for 1 week or longer to investigatethe possibility of OAI.