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Methicillin-resistant Staphylococcus aureus (MRSA)-associated juvenile osteomyelitis of mandible: a rare variant

Rabin Chacko1, Saurabh Kumar2, Valsan Philip Verghese3

  • 1Dental and Oral Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India.

BMJ Case Reports
|July 24, 2021
PubMed

Insights

This study highlights a rare case of pediatric mandibular osteomyelitis caused by Methicillin-resistant Staphylococcus aureus. Conservative antibiotic treatment successfully resolved the infection and symptoms, challenging traditional management approaches.

Area of Science:

  • Pediatric Osteomyelitis
  • Infectious Diseases
  • Skeletal Pathology

Background:

  • Mandibular osteomyelitis in children often presents with swelling and trismus, but the causative agent is frequently unidentified due to low bone culture positivity.
  • Sclerotic osteomyelitis is a challenging diagnosis in the pediatric population, with unclear etiology in many cases.

Observation:

  • An 11-year-old girl with hearing and speech impairment experienced painful right mandibular swelling and progressive trismus.
  • Clinical, radiographic, and histopathological examinations suggested sclerotic osteomyelitis.
  • Bone tissue culture identified Methicillin-resistant Staphylococcus aureus (MRSA), indicating a rare infectious etiology.

Findings:

  • The patient was successfully managed conservatively with antibiotic therapy alone, deviating from the typical combined medical and surgical approach.
  • Significant improvement was observed, including reduced pain, increased mouth opening, and complete radiographic regression of mandibular involvement.

Implications:

  • This case demonstrates that conservative antibiotic management can be effective for pediatric mandibular osteomyelitis, even with MRSA.
  • It suggests a need to reconsider traditional treatment paradigms for this condition.
  • Highlights the importance of identifying specific pathogens like MRSA for targeted therapy.
Keywords:
bone and joint infectionshead and neck surgeryinfectionsmedical managementoral and maxillofacial surgery

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