A 47-year-old woman presented with significant neck pain and bilateral hand paresthesias, ongoing since 2015. Prior to onset, she underwent a posterior fusion of C1/C2 to correct congenital os odontoideum. Subsequent surgeries included revision and removal of instrumentation in addition to occiupt-C3 cervical fusion in 2019, discectomy with C4-5 and C5-6 fusion in 2021, and removal of C1-C2 hardware in July 2022.  

A brain and spine MRI showed extensive T2/FLAIR hyperintensity from the brainstem to C7/T1. Further imaging demonstrated continued significant central cord meningeal edema and a new 0.2 cm mass below the craniocervical junction. CSF studies were unremarkable. She underwent a C1/C2 laminectomy with en bloc removal of right-sided wiring. Biopsy of the epidural mass showed a mixed inflammatory infiltrate with granulation-type tissue and fibrosis. Repeat MRI a few months later demonstrated reduced T2 hyperintensity and edema extending only to C3. Given the location of the myelitis, correlation with the spinal hardware site, exhaustive negative investigations, and symptomatic amelioration post-removal, this presentation strongly indicates reactive myelitis secondary to a foreign body.