Osteomyelitis as a cause of brachial plexus neuropathy

Area of Science:

• Pediatric Neurology
• Infectious Diseases
• Orthopedic Surgery

Background:

• Osteomyelitis, a bone infection, can have serious complications in infants.
• Brachial plexus injuries typically result from trauma or birth complications.
• True paralysis secondary to humeral osteomyelitis is an unreported association.

Observation:

• Two infants under two months old presented with true paralysis.
• Clinical examination revealed brachial plexus involvement.
• Electromyography (EMG) showed significant denervation in upper trunk muscles.

Findings:

• Nerve conduction velocities were normal, ruling out primary nerve damage.
• Patients experienced residual weakness despite antibiotic treatment.
• One infant showed persistent clinical and EMG evidence of lower motor neuron neuropathy 12 months post-treatment.

Implications:

• This case highlights a rare but severe complication of infant osteomyelitis.
• The pathophysiology likely involves ischemic nerve damage due to vasa nervorum occlusion.
• Early recognition and management are crucial for potentially mitigating long-term neurological deficits.