Pediatric C1 Posterior Arch Osteochondroma Presenting as Fever of Unknown Origin and Dizziness WithoutClinical Myelopathy: A Case Report

Background Bony lesions of the atlas (C1) are rare in the pediatric population and typically present with neck pain or myelopathy. Unusual systemic manifestations are seldom reported. Case Presentation: We describe a 13-year-old female who presented with a six-month history of persistent high-grade fever of unknown origin and severe dizziness, with no clinical signs of myelopathy. Extensive systemic investigations were inconclusive. Neuroimaging revealed an expansile bony lesion arising from the right posterior arch of C1, causing severe spinal canal stenosis and radiological evidence of myelopathy. The patient underwent a motion-preserving right C1 hemilaminectomy with complete excision of the lesion under intraoperative neuromonitoring. Histopathological examination confirmed a benign bony lesion consistent with osteochondroma. Results The patient demonstrated rapid post-operative resolution of fever and dizziness following decompression. Conclusion This case highlights an unusual association between high cervical spinal cord compression and unexplained systemic symptoms. Although a direct causal relationship cannot be definitively established, the temporal resolution of symptoms after decompression suggests a possible neurogenic or autonomic mechanism. Early neuroimaging should be considered in pediatric patients with unexplained persistent fever and neurological complaints.