Delayed diagnosis and treatment of pediatric calcaneal acute hematogenous osteomyelitis: A case report

Abstract

Pediatric calcaneal acute hematogenous osteomyelitis (AHO) is a rare condition most often affecting young males. The onset of symptoms is insidious and variable, which may lead to a delay in diagnosis resulting in devastating lifelong sequelae. High clinical suspicion and adequate laboratory and imaging studies are imperative to reach an accurate diagnosis in a timely fashion. We present the case of a 12-year old African American male who was diagnosed with methicillin sensitive <i>Staphylococcus aureus</i> (MSSA) calcaneal osteomyelitis 63 days after symptom onset and two previous misdiagnoses. Treatment included hospital admission, 45 day course of IV antibiotics, 20 sessions of hyperbaric oxygen therapy (HBOT) and eight serial debridements with calcaneal biopsies. The patient was discharged following completion of antibiotic course, HBOT and three sequentially negative calcaneal biopsies. At 12 month follow up he denied pain, sensory deficits and functional disability and had returned to all previous activities. The patient's slightly older than average age, as well as the 63 day time lapse between initial onset of symptoms and diagnosis of AHO, is what makes this case report stand out from previous. To our knowledge, this is the longest reported delay in diagnosis and treatment of pediatric calcaneal AHO to date.