An atypical limping teenager

Area of Science:

• Pediatric Infectious Diseases
• Orthopedic Surgery
• Medical Imaging

Background:

• Septic arthritis is a serious joint infection requiring prompt diagnosis and treatment.
• Staphylococcus aureus is a common pathogen in pediatric septic arthritis.
• Early diagnosis can be challenging, especially with normal initial imaging studies.

Observation:

• A 13-year-old boy presented with a gradual onset left-sided limp, fever, and rigors.
• Physical examination revealed left hip tenderness and inability to bear weight.
• Initial pelvic X-rays and ultrasound were normal, but blood cultures were positive for Staphylococcus aureus.

Findings:

• Magnetic Resonance Imaging (MRI) and Computed Tomography (CT)-guided drainage confirmed left sacroiliac septic arthritis.
• Initial treatment with intravenous ceftriaxone showed limited improvement.
• Subsequent drainage and double intravenous antibiotic therapy resulted in a full recovery.

Implications:

• This case highlights the importance of considering septic arthritis in pediatric patients with limp and systemic symptoms, even with normal initial imaging.
• Early and aggressive management, including surgical drainage and appropriate antibiotic therapy, is crucial for favorable outcomes.
• Staphylococcus aureus septic arthritis of the sacroiliac joint requires a tailored treatment approach for successful resolution.