SHM Converge Scientific Abstract ePoster Gallery-A Case of Brodie's Abscess by Serratia Marcescens Several Years After Elbow Fracture Surgical Correction in a Pediatric Patient

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This case report describes a 14-year-old girl with recurrent right elbow pain and swelling years after an elbow fracture treated with open reduction internal fixation at age 2, with hardware later removed. Over time, she experienced intermittent episodes of pain, swelling, and multiple fractures at the same site, usually controlled with ibuprofen. Her latest episode was more severe, with warmth, circumferential swelling, tenderness, and new tingling in the 3rd to 5th fingers, but no fever or trauma.<br /><br />Laboratory studies showed leukocytosis and elevated inflammatory markers. X-ray suggested joint effusion and soft tissue swelling, while MRI revealed distal humeral osteomyelitis with a 7 mm Brodie’s abscess in the capitellum, communicating with the elbow joint through a sinus tract. MRI also showed septic arthritis, cellulitis, and myositis.<br /><br />Brodie’s abscess is a form of subacute or chronic osteomyelitis that typically affects long bones and often presents with localized pain and swelling, but may lack obvious systemic illness, leading to delayed diagnosis. Common organisms include Staphylococcus, Kingella, Salmonella, and Pseudomonas, and treatment is usually surgical debridement plus antibiotics.<br /><br />In this unusual case, cultures grew Serratia marcescens, a rare cause of Brodie’s abscess in an immunocompetent child. The authors suspect the organism may have been introduced during the original fracture surgery and persisted silently, causing chronic inflammation, weakened bone, recurrent pathologic fractures, and eventually septic arthritis.<br /><br />The patient underwent urgent incision and drainage with debridement. She was initially treated with clindamycin, then switched to ciprofloxacin after cultures showed Serratia sensitivity. She improved clinically, had a negative immunodeficiency workup, and was discharged to complete a 6-month antibiotic course. The report emphasizes considering Brodie’s abscess in children with recurrent non-traumatic bone pain, swelling, or fractures to prevent complications.

Asset Subtitle

Kranthi Nomula

Meta Tag

Author List Angelique Martinez, Kranthi Nomula

Category Clinical Vignettes

Concept Brodie Abscess

Concept Intraosseous Abscess

Concept Magnetic Resonance Imaging

Concept Osteomyelitis

Concept Microbiology-directed antimicrobial therapy

Distinguished Non-Finalist

Presenter Organization Joe DiMaggio Children’s Hospital/Memorial Healthcare System, Hollywood, FL

Presenting Author Kranthi Nomula

Track Pediatric

Keywords

Brodie's abscess

osteomyelitis

septic arthritis

Serratia marcescens

elbow pain

pathologic fractures

pediatric case report

sinus tract

open reduction internal fixation

antibiotic therapy

Brodie Abscess

Intraosseous Abscess

Magnetic Resonance Imaging

Osteomyelitis

Microbiology-directed antimicrobial therapy