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Patel K, Rizzo AN, Bach J, DeVoe W. Suture fixation of traumatic rib fracture flail segment with Klebsiella osteomyelitis. Trauma Case Rep 2024; 51:100996. [PMID: 38633376 PMCID: PMC11021944 DOI: 10.1016/j.tcr.2024.100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
We report the case of a 71-year-old male who initially presented with urosepsis and was found to have a rib fracture of his right 6th rib with a flail segment and an associated abscess. Given the concern for infection, surgical rib fixation with titanium plating was not pursued during the washout of his abscess and instead, he successfully underwent rib fracture stabilization with bilateral suture transfixation. He was continued on a prolonged course of antibiotics for Klebsiella pneumonia osteomyelitis and was discharged uneventfully with optimal pain control and adequate respiratory effort.
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Affiliation(s)
- Krishna Patel
- Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, USA
| | - Anthony N. Rizzo
- Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, USA
| | - John Bach
- Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, USA
| | - William DeVoe
- Surgery, OhioHealth Riverside Methodist Hospital, Columbus 43214, USA
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Lamiri R, Habachi G, Zayani S, Salah RB, Daya A, Abdelaali M, Mekki M, Kechiche N, Sahnoun L. Staphylococcus aureus costal osteomyelitis with complicated by pleural effusion in a 7-month-old infant: A misleading clinical presentation. Radiol Case Rep 2024; 19:2362-2366. [PMID: 38559649 PMCID: PMC10979000 DOI: 10.1016/j.radcr.2024.02.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Osteomyelitis is a rare infectious disease in children, predominantly affecting long bones; however, its clinical presentation can be ambiguous if the location is atypical. Costal osteomyelitis is very rare in children and can mimic other pathologies. We present a case of a seven-month-old infant diagnosed with costal osteomyelitis complicated by rupture of a subperiosteal abscess into the pleura. His clinical condition improved with conservative treatment, which included chest drain insertion and intravenous antibiotic therapy without the need for surgical debridement. Rib osteomyelitis represents a potentially severe condition. Early detection is imperative to prevent the necessity for invasive therapies and mitigate long-term complications.
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Affiliation(s)
- Rachida Lamiri
- Pediatric surgery Department, University Hospital of Monastir, university of Monastir, Monastir, Tunisia
| | - Ghada Habachi
- Pediatric surgery Department, University Hospital of Monastir, university of Monastir, Monastir, Tunisia
| | - Seyfeddine Zayani
- Department of Pediatrics, University Hospital of Monastir, university of Monastir, Monastir, Tunisia
| | - Radhouane Ben Salah
- Pediatric surgery Department, University Hospital of Monastir, university of Monastir, Monastir, Tunisia
| | - Abir Daya
- Department of Pediatrics, University Hospital of Monastir, university of Monastir, Monastir, Tunisia
| | - Mabrouk Abdelaali
- Imagery Department, University Hospital of Monastir, university of Monastir, Monastir, Tunisia
| | - Mongi Mekki
- Pediatric surgery Department, University Hospital of Monastir, university of Monastir, Monastir, Tunisia
| | - Nahla Kechiche
- Pediatric surgery Department, University Hospital of Monastir, university of Monastir, Monastir, Tunisia
| | - Lassaad Sahnoun
- Pediatric surgery Department, University Hospital of Monastir, university of Monastir, Monastir, Tunisia
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Successful Treatment with Antibiotics Alone for Infant Rib Osteomyelitis. Case Rep Pediatr 2022; 2022:3093784. [PMID: 35847833 PMCID: PMC9277467 DOI: 10.1155/2022/3093784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/17/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Pediatric rib osteomyelitis is a rare disease occurring predominantly in the neonatal period and early childhood and accounting for about 1% of all pediatric osteomyelitis. Compared to osteomyelitis in other parts of the body, pediatric rib osteomyelitis shows few localized findings (such as redness and swelling) and often an indolent lesion as well either of which may delay diagnosis and thus make treatment more difficult. A previously healthy one-year-old girl came to our department with a chief complaint of fever lasting for three days. She was admitted to our department to investigate her fever. At the time of admission, radiographs showed decreased permeability in the left lung field; so, we started antimicrobial therapy on the assumption of pneumonia. On the second day of admission, methicillin-susceptible Staphylococcus aureus was detected in the blood culture. A further, more detailed physical examination revealed some slight left anterior chest swelling. We performed a contrast-enhanced CT scan and an MRI and diagnosed her with rib osteomyelitis complicated with a chest wall abscess. She was given intravenous cefazolin for two weeks, switched to oral cephalexin for four weeks, and then recovered completely. She was treated without surgical intervention, having showed a good response to antimicrobial therapy. Osteomyelitis of the ribs in children is reported to be more common in the lower ribs and to occur more frequently in infants. In many cases, the earliest symptoms are nonspecific, so careful examination to detect any subtle abnormalities—such as swelling or mass—is of key importance for early diagnosis in infants. Regarding treatment, most cases of hematogenous osteomyelitis resolve with antimicrobial therapy alone—although surgical intervention may be required in cases of poor response to antimicrobial therapy. Therefore, early diagnosis of rib osteomyelitis through careful physical examination may reduce the chances of requiring surgical intervention.
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Balamohan A, Buchmann RF. Osteomyelitis of the Rib in a Child With Indolent Symptoms. Glob Pediatr Health 2022; 9:2333794X221086583. [PMID: 35400018 PMCID: PMC8990543 DOI: 10.1177/2333794x221086583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/18/2022] [Indexed: 11/15/2022] Open
Abstract
We describe a case of osteomyelitis of the rib caused by methicillin-susceptible Staphylococcus aureus. The patient presented with a subtle, indolent course leading to a suspected 2-year delay in diagnosis. This case highlights that the diagnosis of rib osteomyelitis, which can readily mimic other diagnoses, such as costochondritis, intraabdominal infections, pneumonia, or malignancies warrants a high index of suspicion. Albeit rare, pediatricians should be aware of the possibility of rib osteomyelitis in healthy children to help ensure a prompt diagnosis and appropriate, timely management.
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Affiliation(s)
- Archana Balamohan
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
| | - Robert F Buchmann
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
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Tripathi S, Meena DS, Rohila AK, T R N, Jain V, Kumar D, Yadav T, Garg MK. Empyema necessitans with osteomyelitis of fifth rib due to Nocardia farcinica: a case report. BMC Infect Dis 2021; 21:745. [PMID: 34344324 PMCID: PMC8336093 DOI: 10.1186/s12879-021-06452-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Empyema necessitans is a rare pulmonary condition described as the presence of pus in the pleural cavity with insidious extension into the surrounding soft tissue. The common microbial aetiology of empyema necessitans is tuberculosis. Nocardiosis a cause of empyema necessitans is rarely described in the literature. We herein present a case of an 80-year-old male with empyema necessitans with osteomyelitis of rib caused by Nocardia farcinica. CASE PRESENTATION An 80-year-old male presented with complaints of soft swelling on the left lower posterior chest wall associated with dry cough and breathlessness on exertion. Computed Tomography (CT) thorax demonstrated empyema necessitans with features of left fifth rib osteomyelitis. Radiological guided aspiration of the chest wall collection revealed Nocardia species and surgical drainage of abscess was performed. Matrix-assisted laser desorption/ionization time-of-flight-mass spectrometry (MALDI-TOF-MS) identified the isolate as Nocardia farcinica. He was treated with three-drug regimen: Trimethoprim-sulfamethoxazole, amikacin and ceftriaxone for 2 weeks. After showing improvement patient was discharged and advised to take oral Trimethoprim-sulfamethoxazole for the next 6 months with periodic follow-up. CONCLUSIONS As our case demonstrates, the possibility of invasive Nocardiosis should not be overlooked even in immunocompetent patients. Clinicians should aware of this rare entity while treating patients with empyema necessitans.
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Affiliation(s)
- Swapnil Tripathi
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Durga Shankar Meena
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.
| | - Amit Kumar Rohila
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Neetha T R
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Deepak Kumar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Mahendra Kumar Garg
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
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Reconstruction of E. coli Osteomyelitis of Costa: A Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3413. [PMID: 33680661 PMCID: PMC7929541 DOI: 10.1097/gox.0000000000003413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/10/2020] [Indexed: 11/27/2022]
Abstract
We report a case of E. coli osteomyelitis of the ribs in an immunocompetent 66-year-old man. After radical surgical debridement, bone and soft-tissue defects were covered with a rectus abdominis muscle flap. The postoperative course was uneventful, and there was no recurrence of chest symptoms. Among the various types of osteomyelitis, Gram-negative bacteria such as E. coli osteomyelitis is a relatively rare disease. Osteomyelitis is known to supervene in trauma or postoperative infection and to frequently begin with cellulitis, vascular access, endocarditis, or urinary tract infection, which spreads through the blood to the bone. To add to the difficulty of making a correct diagnosis, the early symptoms of osteomyelitis are often non-specific. We should never forget osteomyelitis in the differential diagnosis of these antecedent infections.
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Mitsui S, Tauchi S, Mizuki S, Tobe S. Extended-spectrum β-lactamase-producing Escherichia coli rib osteomyelitis with debridement and vacuum-assisted closure. BMJ Case Rep 2021; 14:14/1/e238029. [PMID: 33500303 PMCID: PMC7839905 DOI: 10.1136/bcr-2020-238029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Rib osteomyelitis is a rare disease, comprising 1% or less of all osteomyelitis. Treatment of rib osteomyelitis includes prolonged antibiotic therapy and surgical intervention. Indications for surgical treatment of rib osteomyelitis remain unclear, however, because of few reported cases. We report the first known case of extended-spectrum β-lactamase-producing Escherichia coli rib osteomyelitis caused by urosepsis. The 69-year-old male patient remains free of recurrence and symptoms after rib resection and vacuum-assisted closure treatment with antibiotic therapy. Rib osteomyelitis should be considered as differential diagnosis when patients report chest pain after bacteraemic infection. We recommend surgical treatment for patients with drug-resistant bacterial rib osteomyelitis.
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Affiliation(s)
- Suguru Mitsui
- Thoracic Surgery, Akashi Medical Center, Akashi, Hyogo, Japan
| | - Shunsuke Tauchi
- Thoracic Surgery, Akashi Medical Center, Akashi, Hyogo, Japan
| | - Shinpei Mizuki
- Internal Medicine, Akashi Medical Center, Akashi, Hyogo, Japan
| | - Satoshi Tobe
- Thoracic Surgery, Akashi Medical Center, Akashi, Hyogo, Japan
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Osteomyelitis of the ribs in children: a rare and potentially challenging diagnosis. Pediatr Radiol 2020; 50:68-74. [PMID: 31446454 DOI: 10.1007/s00247-019-04505-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/11/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Rib osteomyelitis is rare in children and can mimic other pathologies. Imaging has a major role in the diagnosing rib osteomyelitis. OBJECTIVE To evaluate clinical presentation and imaging findings in children with rib osteomyelitis. MATERIALS AND METHODS We performed a retrospective (2009-2018) study on children with rib osteomyelitis verified by either positive culture or pathology. We excluded children with multifocal osteomyelitis or empyema necessitans. We reviewed medical charts for clinical, laboratory and pathology data, and treatment. All imaging modalities for rib abnormalities were evaluated for presence and location of osteomyelitis and abscess. We calculated descriptive statistics to compare patient demographics, clinical presentation and imaging findings. RESULTS The study group included 10 children (6 boys, 4 girls), with an average age of 7.3 years (range, 3 months to 15.9 years). The most common clinical presentations were fever (n=8) and pain (n=5). Eight children had elevated inflammatory indices (leukocytosis, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]). Localized chest wall swelling was found initially in six children and later in two more children. Rib osteomyelitis was suspected on presentation in only two children. All children had chest radiographs. Rib lytic changes were found on only one chest radiograph, in two of the four ultrasound studies, and in four of eight CTs. Bone marrow signal abnormalities were seen in all eight MRIs. In nine children the osteomyelitis involved the costochondral junction. Six children had an associated abscess. Staphylococcus aureus was cultured in eight children. Osteomyelitis was diagnosed based on pathology in one child with negative cultures. CONCLUSION While rib osteomyelitis is rare, imaging findings of lytic changes at the costochondral junction combined with a history of fever, elevated inflammatory markers or localized soft-tissue swelling in the chest should raise suspicion for this disease.
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10
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Schleifer J, Liteplo AS, Kharasch S. Point-of-Care Ultrasound in a Child with Chest Wall Pain and Rib Osteomyelitis. J Emerg Med 2019; 57:550-553. [PMID: 31591072 DOI: 10.1016/j.jemermed.2019.03.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/12/2019] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnosis of acute osteomyelitis in young children can be challenging due to the lack of specific clinical signs and symptoms. Prompt diagnosis and treatment is essential to prevent complications and to improve long-term prognosis and reduce the need for operative intervention. Point-of-care ultrasound (POCUS) may be a useful tool to detect early changes associated with osteomyelitis. CASE REPORT A 26-month-old boy presented with 6 days of fever and 3 days of focal pain over the right anterior lower ribs without swelling, erythema, or bony deformity, and negative chest x-ray study. A POCUS was performed by the ultrasound fellows and revealed deep soft tissue swelling, periosteal elevation, and increased vascular flow with color Doppler. The patient was admitted to the pediatric service with infectious disease consultation and started on antibiotics. Magnetic resonance imaging confirmed the diagnosis of a right seventh anterior rib osteomyelitis, and the patient subsequently improved and was discharged home. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In this case, the use of POCUS in the emergency department heightened the suspicion for acute osteomyelitis in a rare location and guided early diagnosis and treatment.
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Affiliation(s)
- Jessica Schleifer
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew S Liteplo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Sigmund Kharasch
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Luís MS, Cardosa F, Reis F, Fraga AS, Victor M, Santos JG, Calhau P. RIB OSTEOMYELITIS: A RARE COMPLICATION OF VARICELLA. REVISTA PAULISTA DE PEDIATRIA 2019; 37:510-515. [PMID: 31291442 PMCID: PMC6821478 DOI: 10.1590/1984-0462/;2019;37;4;00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/29/2018] [Indexed: 11/24/2022]
Abstract
Objective: To report a case of varicella complicated by acute osteomyelitis in order to
remind of a rare and potentially serious complication of a very common
pediatric disease. Case description: A previously healthy 3-month-old female infant with 10-day history of
varicella was admitted to the hospital for fever, groan and prostration. The
initial laboratorial evaluation was compatible with bacterial sepsis. By the
third day after admission, a swelling of the seventh left rib had developed.
The ultrasound and scintigraphy evaluation suggested rib osteomyelitis.
Blood cultures were negative. The patient completed six weeks of antibiotics
with favorable clinical, laboratorial and imaging evolution. Comments: Varicella is one of the most frequent exanthematic diseases of childhood and
it is usually self-limited. The most frequent complication is bacterial
infection of cutaneous lesions. Osteoarticular complications are rare, and
rib osteomyelitis is described in less than 1% of cases. The main route of
dissemination is hematogenic, and the most frequent etiological agent is
Staphylococcus aureus. The prognosis is generally good
and depends on early detection and antibiotic initiation.
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Affiliation(s)
- Madalena Sales Luís
- Hospital São Francisco Xavier, Hospital Center "Lisboa Ocidental", EPE, Lisbon, Portugal
| | | | - Filipa Reis
- Hospital Garcia de Orta E.P.E, Almada, Portugal
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Mboutol-Mandavo C, Monka M, Moyikoua RF, Ondima IPL, Miéret JC. Osteomyelitis of flat bones: A report of 20 cases and review of the literature. J Clin Orthop Trauma 2019; 10:1116-1120. [PMID: 31708638 PMCID: PMC6834954 DOI: 10.1016/j.jcot.2019.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Osteomyelitis is frequently localized on the fertile metaphysis of long bones. However, there are other locations such as short or flat bones. The aim of our study was to determine the diagnostic, therapeutic and evolutionary aspects of osteomyelitis of flat bones in our environment. METHODS It's was a retrospective study conducted from January 2013 to December 2017; Children from 0 to 16 years admitted for osteomyelitis of a flat bone where included. RESULTS We followed 19 patients who presented 20 locations of osteomyelitis on a flat bone. They accounted for 9.1% of all osteomyelitis observed during the study period. The average age was 6.7 years (9 months-14 years). The clinical picture most often associated with fever and local inflammatory swelling related to an abscess. The predominant locations were the sternum with 8 cases and the scapula with 4 cases. Eleven patients were homozygous sickle cell patients. The diagnosis was strengthened with standard radiography in the majority of cases. A micro-organism was isolated in 8 cases (40%) and Staphylococcus aureus was the predominant germ in 7 cases. Nearly all patients were treated with surgical drainage of the abscess, bone curettage and antibiotics. A typical radiographical evolution has been observed with bone reconstruction in 15 cases with a mean follow-up of 3.3 years. CONCLUSION Flat bones are relatively rare locations of osteomyelitis. Standard radiography remains the first-line examination. Their treatment obeys the same rules as that of osteomyelitis of long bones. There is a successful outcome when the care is early and adequate.
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Affiliation(s)
- Caryne Mboutol-Mandavo
- Faculty of Health Sciences of Marien Ngouabi University of Brazzaville, Congo
- Department of Paediatric Surgery, University Hospital of Brazzaville, Congo
- Corresponding author. Paediatric surgery Department of University Hospital of Brazzaville. 13, Boulevard Auxence Ikonga PO Box: 32, Congo.
| | - Marius Monka
- Faculty of Health Sciences of Marien Ngouabi University of Brazzaville, Congo
- Department of Trauma and Orthopaedics, University Hospital of Brazzaville, Congo
| | - Regis Franck Moyikoua
- Faculty of Health Sciences of Marien Ngouabi University of Brazzaville, Congo
- Department of Radiology, University Hospital of Brazzaville, Congo
| | - Irène Patricia Lucienne Ondima
- Faculty of Health Sciences of Marien Ngouabi University of Brazzaville, Congo
- Department of Paediatric Surgery, University Hospital of Brazzaville, Congo
| | - Jean-Claude Miéret
- Department of Paediatric Surgery, University Hospital of Brazzaville, Congo
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Nibley P, Kraus C. Rib Osteomyelitis in a Pediatric Patient: Case Report and Review of the Literature. Clin Pract Cases Emerg Med 2018; 2:294-296. [PMID: 30443609 PMCID: PMC6230369 DOI: 10.5811/cpcem.2018.9.39481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022] Open
Abstract
We present a case report and review of the literature of rib osteomyelitis in a pediatric patient presenting to the emergency department (ED) with fever and increased work of breathing. The patient was seen on a return visit to the ED after discharge with presumed viral illness approximately 12 hours prior. On the second ED visit, there was concern for occult bacteremia, and work-up ultimately revealed a subperiosteal abscess with rib osteomyelitis, a rare etiology for fever in the pediatric patient. The patient was treated with antibiotics, had surgical debridement, and fully recovered.
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Affiliation(s)
| | - Chadd Kraus
- Geisinger Health, Department of Emergency Medicine, Danville, Pennsylvania
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Kashyap NK, Jindal A, Borkar NK, Wasnik M. Primary Tuberculotic Osteomyelitis of Rib in a Child. J Clin Diagn Res 2017; 11:PD08-PD09. [PMID: 28892970 DOI: 10.7860/jcdr/2017/25974.10222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/12/2017] [Indexed: 11/24/2022]
Abstract
Although extremely rare, osteomyelitis has been reported in smaller bones like ribs. A 13-year-old male child presented with a one week history of chest wall swelling. Fine Needle Aspiration Cytology (FNAC) of the lesion and initial bacterial culture could not find the aetiology of the lesion. He underwent surgical resection of entire sixth rib for osteomyelitis and was subsequently diagnosed to have tubercular osteomyelitis. Diagnosis and treatment of rib tuberculosis is both difficult and controversial. Rib tuberculosis is often not successfully treated by medical management alone and consequently needs surgery.
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Affiliation(s)
- Nitin Kumar Kashyap
- Assistant Professor, Department of Trauma and Emergency, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Atul Jindal
- Assistant Professor, Department of Paediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Nitin Kumar Borkar
- Associate Professor, Department of Paediatric Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Minal Wasnik
- Associate Professor, Department of Pathology, RIMS, Raipur, Chhattisgarh, India
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Idrissa S, Tazi M, Cherrabi H, Souley A, Mahmoudi A, Elmadi A, Khattala K, Bouabdallah Y. Multifocal rib osteomyelitis in children: a case report and literature review. J Surg Case Rep 2017; 2017:rjx142. [PMID: 28852459 PMCID: PMC5569973 DOI: 10.1093/jscr/rjx142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/11/2017] [Accepted: 07/12/2017] [Indexed: 11/13/2022] Open
Abstract
Rib osteomyelitis is a rare disease, occurring in ~1% or less of all cases of haematogenous osteomyelitis. During the last century, 58 cases of rib osteomyelitis were reported in the literature, of which, multiple ribs were involved in only five patients. Because of its rarity and non-specific clinical signs, diagnostic of rib osteomyelitis may be delayed. We report a case of multifocal rib osteomyelitis revealed by a dorsal mass in a healthy 13-year-old female child.
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Affiliation(s)
- Salahoudine Idrissa
- Department of Pediatric Surgery, University Hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, Fez,Morocco
| | - Mohamed Tazi
- Department of Pediatric Surgery, University Hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, Fez,Morocco
| | - Hind Cherrabi
- Department of Pediatric Surgery, University Hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, Fez,Morocco
| | - Abdoulaziz Souley
- Department of Radiology, University Hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Abdelhalim Mahmoudi
- Department of Pediatric Surgery, University Hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, Fez,Morocco
| | - Aziz Elmadi
- Department of Pediatric Surgery, University Hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, Fez,Morocco
| | - Khalid Khattala
- Department of Pediatric Surgery, University Hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, Fez,Morocco
| | - Youssef Bouabdallah
- Department of Pediatric Surgery, University Hospital of Hassan II, University of Sidi Mohamed Ben Abdellah, Fez,Morocco
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Esposito S, Pinzani R, Raffaeli G, Lucchi T, Agostoni C, Principi N. A young infant with transient severe hypertriglyceridemia temporarily associated with meropenem administration: A case report and review of the literature. Medicine (Baltimore) 2016; 95:e4872. [PMID: 27661029 PMCID: PMC5044899 DOI: 10.1097/md.0000000000004872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Slight changes in the lipid profile can be observed over the acute phase of infectious diseases. Moreover, some anti-infective drugs can modify serum lipid concentrations, although antibiotics do not seem to have a relevant, direct, or acute effect on the lipid profile. METHODS A 75-day-old breastfed Caucasian female, born at term after a regular pregnancy, was hospitalized for osteomyelitis. She was immediately treated with intravenous meropenem and vancomycin. Therapy was effective, but after 22 days of treatment, her blood was found to be viscous with a purple shade. RESULTS A fasting blood sample showed serum triglycerides of 966 mg/dL, total cholesterol of 258 mg/dL, and high-density lipoprotein cholesterol of 15 mg/dL. Secondary causes of hyperlipidemia and primary hereditary disorders were ruled out. Thereafter, the possibility that antibiotics may have had a role in the hypertriglyceridemia was considered, and meropenem was discontinued. After 72 hours of meropenem discontinuation, a sharp modification of lipid variables was observed, and further testing showed a complete normalization of the lipid profile. CONCLUSION In this child with osteomyelitis, the increase in serum triglycerides appeared suddenly after 3 weeks of meropenem treatment and resolved quickly after meropenem discontinuation, thus highlighting the possible association between meropenem and lipid profile alterations. Monitoring the lipid profile should be considered in cases of long-term treatment with meropenem, and further studies on meropenem safety should include evaluation of the lipid profile.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Correspondence: Prof Susanna Esposito, Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, I-20122 Milan, Italy (e-mail: )
| | - Raffaella Pinzani
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Genny Raffaeli
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tiziano Lucchi
- Metabolic Disease Clinic, Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostoni
- Pediatric Medium Intensity Care Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Raffaeli G, Borzani I, Pinzani R, Giannitto C, Principi N, Esposito S. Abdominal mass hiding rib osteomyelitis. Ital J Pediatr 2016; 42:37. [PMID: 27068333 PMCID: PMC4828859 DOI: 10.1186/s13052-016-0251-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/04/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Rib osteomyelitis is a rare entity, occurring in approximately 1 % or less of all cases of haematogenous osteomyelitis. Given its rarity and clinical heterogeneity, the diagnosis of rib osteomyelitis can be challenging and requires a high index of suspicion. We present a case of acute osteomyelitis of the rib due to community-acquired methicillin-resistant Staphylococcus aureus (MRSA), which occurred in an otherwise healthy 3-month-old infant and mimicked an epigastric hernia at first. CASE PRESENTATION An otherwise healthy 3-month-old female infant was sent by her primary care paediatrician to the paediatric emergency department for possible incarcerated epigastric hernia because for 2 days, she had suffered from mild to moderate fever, irritability, poor feeding, and tender epigastric swelling. Ultrasonographic imaging excluded epigastric hernia, and transthoracic echocardiography ruled out endocarditis. However, clinical assessment combined with laboratory criteria classified the child into the high-risk group for having severe bacterial infection. Consequently, awaiting the definitive diagnosis, she was immediately treated with a broad-spectrum regimen of intravenous antibiotic therapy based on vancomycin (40 mg/kg/die in 3 doses) and meropenem (100 mg/kg/die in 3 doses). Three days after admission, the blood culture result was positive for methicillin-resistant Staphylococcus aureus, and vancomycin remained as antibiotic therapy. On day 3, a second swelling appeared at the level of the seventh left rib, 2 cm-wide, non-erythematous, mildly painful. Ultrasonography of the left chest wall on this occasion showed an image consistent with an acute osteomyelitis of the anterior osteo-chondral region of the 7th rib and associated adjacent periosteal and soft tissue collection and magnetic resonance imaging confirmed the osteomyelitis of the anterior middle-distal part of the 7th left rib, near the costochondral junction. Vancomycin was continued up to a total of 6 weeks of therapy, and at the end, the child was discharged in good condition with no relapse during the follow-up. CONCLUSION This is one of the few reported cases of paediatric rib osteomyelitis caused by community-acquired MRSA. Timely identification associated with prompt and targeted antibiotic therapy may allow full recovery.
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Affiliation(s)
- Genny Raffaeli
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Irene Borzani
- Pediatric Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Pinzani
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Caterina Giannitto
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
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Abstract
Acute osteomyelitis is uncommon in full-term neonates and occurs most frequently in those with critical illnesses, often following episodes of sepsis, skin infection, umbilical catheterization, urinary tract anomalies, or a complicated delivery. Here, we report a very rare case of acute rib osteomyelitis due to Staphylococcus aureus in a 13-day-old full-term male neonate. Ultrasonography (US) enabled diagnosis and revealed a coexisting costochondral junction rib fracture, which was not detected on routine chest radiography. Following a 29-day course of intensive parenteral antibiotic therapy, the patient was discharged in good health at 42 days of age without any scar formation. Due to its accessibility and safety, US can be a promising modality for detecting acute osteomyelitis in neonates with clinically highly suspected conditions in the neonatal intensive care unit setting, particularly those involving thin and mobile bones subject to respiratory motion. However, further studies are required to assess the utility of US in these cases and negative results. In low-risk neonates with osteomyelitis, an accompanying fracture should be considered.
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Affiliation(s)
- Sahoko Ono
- Department of Pediatrics, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Hiroki Fujimoto
- Department of Neonatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yutaka Kawamoto
- Department of Neonatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
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