SHM Converge Scientific Abstract ePoster Gallery-Acute Hematogenous Septic Arthritis Complicating Treatment of Rickets

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This case describes a 3-year-old boy with eczema and a severe dairy allergy who presented with one month of worsening inability to walk. He was afebrile and initially had full range of motion without swelling or point tenderness, but exam showed classic signs of severe nutritional deficiency, including frontal bossing, genu varum, angular cheilitis, and widespread eczema. Diet history revealed extreme restriction, with breastfeeding and a very limited intake of fries, tater tots, and chips. Growth evaluation showed preserved weight but marked height failure.<br /><br />Laboratory and imaging workup confirmed nutritional rickets with profound deficiencies: low calcium, low vitamin D, elevated alkaline phosphatase, elevated PTH, metabolic acidosis, osteopenia, and metaphyseal widening/fraying on x-ray. He was admitted for calcium replacement and nutritional rehabilitation, including vitamin supplementation and NG feeding support.<br /><br />During hospitalization, he developed fever and later refused to use his right arm. MRI demonstrated a small right shoulder effusion with synovitis and surrounding myositis concerning for infection. Arthrocentesis confirmed acute septic arthritis, with joint fluid showing high WBC count and gram-positive cocci. Blood cultures grew methicillin-susceptible Staphylococcus aureus (MSSA). He was treated with IV cefazolin, then transitioned to oral antibiotics, and discharged with close follow-up and outpatient therapy.<br /><br />The authors propose several mechanisms linking rickets treatment and septic arthritis risk: improved bone perfusion during mineralization, immune dysfunction from vitamin D deficiency, skin barrier disruption from eczema and micronutrient deficiency, and repeated intravenous access. This case highlights the importance of recognizing that children with rickets, especially those with atopic dermatitis and severe dietary deficiency, may be at increased risk for invasive MSSA infection.

Asset Subtitle

Emily A. Kelsoe

Meta Tag

Author List Amy E. Ensing, Emily A. Kelsoe

Category Clinical Vignettes

Concept Rickets

Concept Septic Arthritis

Concept Vitamin D Deficiency

Concept Osteomyelitis

Concept Arthrocentesis

Distinguished Non-Finalist

Presenter Organization Washington University - St. Louis Children's Hospital

Presenting Author Emily A. Kelsoe

Track Pediatric

Keywords

rickets

vitamin D deficiency

septic arthritis

MSSA

eczema

nutritional deficiency

dairy allergy

osteopenia

metaphyseal fraying

pediatric infection

Rickets

Septic Arthritis

Vitamin D Deficiency

Osteomyelitis

Arthrocentesis