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Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia
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Abdominal mass hiding rib osteomyelitis.

Genny Raffaeli1, Irene Borzani2, Raffaella Pinzani1

  • 1Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.

Italian Journal of Pediatrics
|April 13, 2016
PubMed
Summary

This case highlights a rare instance of pediatric rib osteomyelitis caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in an infant. Prompt antibiotic treatment led to a full recovery, demonstrating the importance of early diagnosis for this challenging condition.

Keywords:
Bone infectionMRSAOsteomyelitisRibStaphylococcus aureus

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Area of Science:

  • Pediatric Infectious Diseases
  • Orthopedic Infections
  • Medical Imaging in Pediatrics

Background:

  • Rib osteomyelitis is a rare hematogenous bone infection, accounting for less than 1% of osteomyelitis cases.
  • Diagnosis can be challenging due to its rarity and varied clinical presentation.
  • Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly recognized pathogen in pediatric infections.

Observation:

  • A 3-month-old infant presented with symptoms mimicking an epigastric hernia, including fever, irritability, and swelling.
  • Initial imaging ruled out hernia and endocarditis, but clinical signs suggested a severe bacterial infection.
  • Subsequent imaging revealed acute osteomyelitis of the 7th left rib with associated soft tissue collection.

Findings:

  • Blood cultures identified community-acquired MRSA as the causative agent.
  • The infant received intravenous vancomycin for 6 weeks, with successful treatment and no relapse.
  • This case represents one of the few documented instances of pediatric rib osteomyelitis due to community-acquired MRSA.

Implications:

  • Early and accurate diagnosis of pediatric rib osteomyelitis is crucial, despite its rarity.
  • Prompt initiation of targeted antibiotic therapy, such as vancomycin for MRSA, is essential for favorable outcomes.
  • This case underscores the need for a high index of suspicion for unusual infections in infants presenting with non-specific symptoms.