A 10-year-old child with acute torticollis due to polymicrobial deep neck infection

Abstract

Torticollis in children can be a sign of a potentially dangerous disease; the correct diagnosis is not always obvious on history and physical examination. The use of point-of-care ultrasound (POCUS) helps to limit the differential diagnosis and direct appropriate further laboratory and radiology-performed evaluation. We present a case of a 10-year-old child whose deep neck infection (DNI) was timely diagnosed in the paediatric emergency department by early use of POCUS and drained under POCUS guidance after admission to the hospital. The culture from the fluid grew Eikenella corrodens, Streptococcus constellatus and Prevotella buccae This case demonstrates that DNIs occur in children with acute acquired torticollis, even without fever and demonstrates the importance of early use of POCUS in cases where DNI is a potential diagnosis. Moreover, this case emphasises the importance of microbiological identification of DNIs that can be the key to successful treatment.

Keywords: ear; infectious diseases; nose and throat/otolaryngology; paediatrics; ultrasonography.

Figure 1

Photo of the patient on day of presentation. He displays the classic cock-robin position of spasmodic torticollis, and has no significant swelling or erythema of the anterior neck.

Figure 2

Colour Doppler image of the anterior neck with a linear high frequency probe in transverse orientation. An abscess sits in the centre of the image (StAR), surrounded by blood flow. To the left are the hyperechoic rings of trachea (downward arrow), below is the oesophagus (rightward arrow) and to the right are the great vessels of the neck (x).

Figure 3

Diagram showing the location of infected fourth branchial cyst relative to major anatomical structures. (Illustration created by AG).