Osteomyelitis of the cervical spine presenting as a neurenteric cyst

A healthy 3-week-old baby girl developed a cyanotic spell that required intubation and ventilation. During part of her initial emergency examination and treatment, a neck mass was felt, and a positive blood culture grew staphylococcus aureus. She was transferred to the ICU, and was ventilated and treated with intravenous cloxacillin. Bronchoscopy showed a paralyzed left cord. Computerized tomography (CT) scan of her neck showed a midline mediastinal mass (behind the compressed trachea and esophagus), that extended from C7 to the carina. Because of the suspicion of an abnormal C7 vertebral body, diagnosis of a neurenteric cyst was made, and a myelogram showed a complete block at the T1 level and an absent C7 vertebral body. There were no neurologic signs. Her right knee then became red and swollen, and x-rays showed a lytic area in the distal femur. This knee was explored under general anesthesia, and an osteomyelitis found and drained. Several days later, a barium swallow showed the mediastinal mass pushing the esophagus to the left, but several more cervical vertebrae were "missing," and the diagnosis of osteomyelitis of the cervical spine was confirmed. The mediastinal staphylococcal abscess was then drained through the neck. Follow-up has been unremarkable over the last 4 years.