Pelvic osteomyelitis: a diagnostic challenge in children

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.