Acute hematogenous osteomyelitis due to Salmonella in a pediatric patient: a case report

Abstract

Acute hematogenous osteomyelitis is an inflammatory process in the bone tissue. It’s usually of bacterial etiology, caused by a contiguous infection focus. In pediatric patients, the main isolated pathogen is Staphylococcus aureus. Salmonella spp. as a causative agent of osteomyelitis is infrequent; it can be found in less than 1% of the casesand it is generally associated with risk factors. We analyze the case of a 4 years old male patient known to be healthy, who enters the emergency service with a 2 weeks of increasing fever and difficulty when walking. Upon physical examination, he presented acute pain, edema and a local increased temperature in the right ankle. He was hospitalized for suspicion of septic arthritis and he was treated empirically with clindamycin. Positive cultures were reported for Salmonella spp, isolated from blood and a tibia’s secretion sample. The betalactambased approach, specifically third-generation cephalosporins, is recommended in international treatment guidelines, so the success of the use of ampicillin was expected. Thus, identifying the etiological agent of the infectious process is determinant in the success of antibiotic therapy, as well as the joint approach of the medical personnel and the laboratory service.