Pitfalls in diagnosis of osteomyelitis in children with sickle cell disease

The cases of three children with unusual features of osteomyelitis and sickle cell disease are presented. Two children had salmonella osteomyelitis, one with a recurrence 1.5 years after adequate intravenous therapy. In the second, the bone scan was negative despite verified disease. The causative organism in the third case was Staphylococcus aureus, and there was extensive bone involvement of the radius without symptoms, but with a positive bone scan. It is recommended that the possibility of osteomyelitis be entertained in a child with sickle cell disease whenever there are symptoms and/or objective findings referrable to bone. Radionuclide scans, when used in timely fashion, can assist in the diagnosis, but confirmation can best be achieved by the recovery of microorganisms through blood culture and/or bone aspirate. The choice, dosage, and duration of antibiotic therapy should be determined by causative organisms and by serologic titers.