Meningococcal osteomyelitis in a premature infant

The authors report a rare case of acute hematogenous osteomyelitis in a premature very low-birth weight infant caused by Neisseria meningitidis, a microorganism which occasionally causes arthritis, but is very rarely involved in bone infections. The strong teamwork of clinicians, the clinical microbiologist and the radiologist allowed the prompt formulation and confirmation of the clinical suspect (regardless of the paucity of symptoms and systemic signs), the rapid isolation of the microorganism and the prompt initiation of a specific therapy, thus obviating the need for a more invasive bone biopsy, which would have been hazardous considering the risks associated with an invasive procedure, and much higher in our case because of the young age of the patient and his prematurity. Moreover, this case confirms that early ultrasonographic examination may anticipate the diagnosis and the initiation of therapy in case of a clinical suspicion of acute hematogenous osteomyelitis, thus avoiding serious complications such as growth disorders or arrest, shortening or angular deformity, loss of motion and degenerative osteoarthritis. In accordance with what suggested in the literature, initial parenteral treatment followed early by oral antibiotics was chosen, with an excellent outcome.