Similarities and Differences between Clavicular Bacterial Osteomyelitis and Nonbacterial Osteitis: Comparisons of 327 Reported Cases

Salmonella Typhi sternoclavicular abscess with osteomyelitis-a rare case report

Salmonella Typhi osteomyelitis is a rare occurrence as compared to enteric fever and diarrhoea which are common manifestations caused by this microorganism. In reported cases of Salmonella osteomyelitis, commonly involved sites are long bones like the femur and humerus. Uncommon reports of Salmonella osteomyelitis from sites such as radius, ulna, tibia and vertebrae have also emerged. Extremely rare incidences of the same have been reported from the clavicle, skull and small bones of hands. Osteomyelitis could be bacterial or non-bacterial, and among bacterial osteomyelitis, Salmonella Typhi is a very rare entity. We present a case of Salmonella osteomyelitis and discuss the importance of microbiological diagnosis of osteomyelitis in diagnosing unusual pathogens from unusual sites. This case report is unique due to its site and difference in clinical presentation. The difference in presentation in an elderly immunocompetent male with no major comorbidities was different from other reported cases. Our patient was successfully managed with surgical debridement followed by a series of vacuum dressings and intravenous antibiotics for 6 weeks.

Chronic Nonbacterial Osteomyelitis of the Jaw in a 3-Year-Old Girl

Differential diagnosis of bacterial osteomyelitis (BOM) and chronic nonbacterial osteomyelitis (CNO) is challenging. Pediatric CNO can be diagnosed at around 10 years of age and when CNO cases involve only the jaw, it is difficult to make a diagnosis in a young child. A 3-year-old female developed CNO at the jaw alone. She presented with no fever, right jaw pain, mild trismus, and a preauricular facial swelling around the right mandible. Computed tomography (CT) revealed a hyperostotic right mandible, with osteolytic and sclerotic changes associated with periosteal reaction. At first, we suspected BOM and antibiotics were administered. Subsequently, CNO was diagnosed, and the patient received flurbiprofen (a nonsteroidal anti-inflammatory drug (NSAIDs)). Lack of a sufficient response led to successful treatment with a combination of oral alendronate and flurbiprofen. Physicians should be aware of CNO, a rare autoinflammatory noninfectious bone disease of unknown etiology, even in young children, although the disease mostly affects older children and adolescents.

Sternoclavicular Septic Arthritis Caused by Cutibacterium acnes in a Previously Healthy 13-Year-Old Male: A Case Report

CASE

A 13-year-old boy presented with 3 weeks of atraumatic left-sided sternoclavicular (SC) joint pain, swelling, and decreased range of motion. After imaging and laboratory workup, he underwent operative irrigation, debridement, and antibiotic therapy with complete resolution of his symptoms. Surgical cultures were consistent with SC septic arthritis.

CONCLUSION

The management of septic arthritis in pediatric patients remains varied. Here, we present the only report of SC septic arthritis due to Cutibacterium acnes in a healthy pediatric patient. Given the similar clinical findings of pain and swelling to affected bones and joints, differentiating SC septic arthritis from other conditions within the clinical spectrum of chronic nonbacterial osteomyelitis remains challenging. Clinicians should maintain a high index of suspicion when patients present with pain and swelling over the SC joint.