Bilaterally Symmetrical Serratia Osteomyelitis of Distal Third Radius in an Adolescent Female with Sickle Cell...

Osteomyelitis as a condition in adolescents is difficult to diagnose as it is. In patients with sickle cell disease, the diagnosis is even more difficult due to the occurrence of Vaso occlusive crisis which being the most common acute clinical manifestation of sickle cell disease in bone may mimic osteomyelitis. No single clinical presentation, laboratory result, or imaging finding can definitively distinguish these diagnoses.

A 15-year-old female presented to the outpatient department with mild pain and swelling in both forearms persisting for the past 3 months. Radiographs revealed predominantly diaphyseal expansile osteolytic lesions in the bilateral distal third radius with periosteal reaction along with a small radiolucent area in the right distal radius. She was subsequently admitted for further assessment. On the 3rd day of admission, pus pointing was noted on the volar aspect of the right forearm while the left side only had bony swelling. Surgical intervention (debridement with saucerization) was performed on both sides. Pus culture (collected intraoperatively) showed Serratia marcescens as the causative organism. Culture-sensitive antibiotics were administered intravenously for 3 weeks followed by oral antibiotics for 3 weeks. At 1-year follow-up near complete resolution of bony lesions with full range of motion in both upper limbs was noted.

Subacute osteomyelitis may present with just bony swelling without significant pain or fever and can present a diagnostic dilemma, a high index of suspicion is important to rule out other conditions and diagnose osteomyelitis in such cases. Unusual organisms like Serratia can cause osteomyelitis in immunodeficient patients like those with sickle cell disease. Appropriate management in the form of thorough surgical debridement, saucerization, and appropriate antibiotics can lead to complete resolution of the infection with good clinical results.