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Pelvic osteomyelitis: a diagnostic challenge in children
Christina Weber-Chrysochoou1, Natascha Corti, Philippe Goetschel
1Division of Infectious Diseases, University Children's Hospital Zurich, 8032 Zurich, Switzerland.
Insights
Pelvic osteomyelitis is rare in children but presents with limping. Early diagnosis with imaging and prompt antibiotic treatment leads to complete recovery in acute hematogenous osteomyelitis cases.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Medical Imaging
Background:
- Acute hematogenous osteomyelitis (AHOM) typically affects long bones in children.
- Pelvic AHOM is an uncommon presentation and often misdiagnosed initially.
Purpose of the Study:
- To review institutional experience with pelvic AHOM in children.
- To compare findings with existing literature on pelvic AHOM.
Main Methods:
- Retrospective analysis of children diagnosed with pelvic AHOM between 1984 and 2003.
- Comparison of clinical data with published cases.
Main Results:
- Nineteen children (9%) with pelvic AHOM were older than typical AHOM patients.
- Limping or refusal to walk was universal; fever and elevated inflammatory markers were common.
- Staphylococcus aureus was the most frequent pathogen; scintigraphy and MRI were highly diagnostic.
- Diagnosis averaged 3 days from symptom onset, with complete resolution after antibiotic therapy.
Conclusions:
- Pelvic AHOM should be suspected in children with hip, thigh, or abdominal pain and limping.
- Diagnostic imaging (scintigraphy, MRI) and microbiological workup are crucial for targeted antibiotic therapy.
- Prompt diagnosis and treatment result in excellent outcomes for pediatric pelvic AHOM.
Background:
Acute hematogenous osteomyelitis (AHOM) in children usually occurs in tubular bones. Acute hematogenous osteomyelitis of the pelvis is rare and is often not recognized primarily.
Methods:
To review the experience with pelvic AHOM at our institution, we analyzed records from children diagnosed with pelvic AHOM (1984-2003) and compared with those reported in the literature.
Results:
Among 220 children with AHOM (median age, 6.4 years), those 19 (9%) with pelvic AHOM were significantly older (median age, 9.0 years; range, 0.04-15.6). All children presented with limping or refused to walk. Twelve of 19 patients were febrile, 16 of 18 had elevated C-reactive protein (>20 mg/L), and 6 of 19 had leukocytes greater than 12 G/L. Staphylococcus aureus was isolated from blood or bone aspirates in 9 of 17 patients, and Streptococcus pneumoniae was isolated in 1. Scintigraphy was diagnostic in 15 of 15 children, and magnetic resonance imaging in 7 of 7 children. The mean time between initial symptoms and diagnosis was 3 days (range, 1-8 days). Infection resolved completely in all children after antibiotic therapy.
Conclusion:
Pelvic AHOM should be considered in children with limping and pain referred to the hip, thigh, or abdomen. Diagnosis by scintigraphy or magnetic resonance imaging followed by local puncture and microbiological workup allows for specific antibiotic treatment and results in an excellent outcome of pelvic AHOM.
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