Propionibacterium acnes Osteomyelitis after Intraosseous Cannulation in a Child

Area of Science:

• Pediatric Infectious Diseases
• Orthopedic Surgery
• Medical Device Complications

Background:

• Intraosseous (IO) cannulation is a critical route for fluid resuscitation in pediatric emergencies.
• Osteomyelitis, a bone infection, can arise as a complication of invasive procedures.
• Propionibacterium acnes (P. acnes) is a bacterium not commonly associated with severe osteomyelitis.

Observation:

• A rare case of P. acnes tibial osteomyelitis occurred in a 4-year-old child following IO cannulation.
• The infection manifested three months after the initial procedure, which involved fluid resuscitation for streptococcal toxic shock syndrome.
• The patient required irrigation, debridement, and prolonged antibiotic therapy.

Findings:

• P. acnes can cause osteomyelitis at the IO access site, even in immunocompetent children.
• Delayed diagnosis is possible due to low-grade, persistent symptoms mimicking other conditions.
• Magnetic resonance imaging (MRI) is crucial for accurate diagnosis and treatment planning.

Implications:

• Clinicians should maintain a high index of suspicion for osteomyelitis in patients with ongoing pain after IO cannulation.
• Consideration of less common pathogens like P. acnes is important for persistent post-procedural symptoms.
• Prompt diagnosis and appropriate management, including advanced imaging, are vital for favorable outcomes in pediatric osteomyelitis.