SHM Converge Scientific Abstract ePoster Gallery-Two Bones to Pick: Multifocal Acute Osteomyelitis in an Infant

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A previously healthy, under-vaccinated 9-month-old boy presented with two days of right arm swelling and refusal to move the arm, along with intermittent fevers. Exam showed erythema and edema of the right hand and distal forearm, as well as warmth and swelling of the right thigh with refusal to stand. Initial labs demonstrated marked inflammation, including elevated CRP and ESR, with mildly elevated procalcitonin; blood cultures were negative and COVID PCR was positive. Hip ultrasound showed no effusion.<br /><br />Because of persistent concern for a deeper musculoskeletal infection, MRI of the right lower extremity was obtained and revealed epiphyseal osteomyelitis/chondritis of the right knee, metaphyseal osteomyelitis, and an intramuscular abscess in the lateral gastrocnemius. Due to proximity to the growth plate, a core needle biopsy was performed, and culture grew Group A Streptococcus. The patient was discharged on long-term antibiotics with Infectious Disease follow-up.<br /><br />This case highlights that acute hematogenous osteomyelitis, though uncommon in infants, can present in a multifocal pattern involving more than one site. It may spread hematogenously, by direct inoculation, or by local extension. Clinicians should consider osteomyelitis even when symptoms suggest multiple joints or limbs, since delayed diagnosis can lead to serious complications such as recurrent infection, pathologic fractures, chronic functional impairment, and death.

Asset Subtitle

Rachel H. Bharwani

Meta Tag

Author List Kate Wimberly, Kelly E. Miller, Rachel H. Bharwani

Category Clinical Vignettes

Concept Acute Hematogenous Osteomyelitis

Concept Refusal to Move Extremity

Concept Multifocal Involvement

Concept Magnetic Resonance Imaging

Concept Biopsy

Distinguished Non-Finalist

Presenter Organization University of Kentucky

Presenting Author Rachel H. Bharwani

Track Pediatric

Keywords

acute hematogenous osteomyelitis

infant

multifocal infection

Group A Streptococcus

epiphyseal osteomyelitis

metaphyseal osteomyelitis

intramuscular abscess

MRI diagnosis

elevated CRP and ESR

under-vaccinated

Acute Hematogenous Osteomyelitis

Refusal to Move Extremity

Multifocal Involvement

Magnetic Resonance Imaging

Biopsy