Introduction: Severe upper respiratory tract infection can cause inflammation around the atlanto-axial joint, spreading via the pharyngo-vertebral veins to cervical ligaments, leading to laxity and non-traumatic rotatory subluxation of the joint . Case report: A four-year-old child presented with right-sided neck pain, swelling, restrictedmovement without preceding trauma and no fever. Examination revealed right cervical lymphadenopathy with a neck tilt. Rest of the examinations were unremarkable, revealing WBC 20.7 x 109/L, Neutrophil 80.6%, CRP 20.98mg/L and ESR 96 mm/h. The patient was managed with intravenous co-amoxyclav and oral clindamycin along with analgesics, muscle relaxants and physiotherapy . Neck tilt persisted despite improvement of cervical lymphadenopathy . CT imaging revealed severe atlanto-axial dislocation . The patient made a complete recovery following three days of cervical traction without neurologicalsequelae. Follow-up imaging showed normalization of the anterior atlanto-axial interval. Discussion: Grisel’s syndrome, a rare inflammatory atlanto-axial instability often triggered by upper respiratory tract infection is confirmed by CT imaging; MRI assesses soft tissue and cord involvement. Management may require surgical reduction if traction fails to avoid long term neurological sequelae. Cervical lymphadenopathy is a common childhood infectious or para infectious illness, yet uncommon complications needs awareness and vigilance.