Abstract
Osteomyelitis in children is often secondary to haematogenous dissemination of bacteria into long bone metaphyses. Organisms causing osteomyelitis vary with age, and the virulence of different pathogens influences clinical presentation.1 Aetiological diagnosis is important in determining appropriate antibiotic therapy. This case involves an 11-year-old girl with 4 months worsening left knee pain and difficulty weight bearing. She had no fever, preceding trauma or recent dental procedures. Inflammatory markers were unremarkable, with radiological evidence of a Brodie’s abscess. She was trialled on oral cephalexin; despite transient clinical improvement, she re-presented with worsening symptoms. She was afebrile, with distal femoral point tenderness, no evidence of knee joint involvement and 1/6 mid-systolic murmur at the pulmonic area. Intravenous flucloxacillin was commenced, with debridement and washout of the distal femoral lesion. Surgical specimens grew Aggregetibacter aphrophilus sensitive to ampicillin, with negative blood cultures. Transthoracic echocardiography showed no valvular abnormalities. Her mobility improved, and she was transitioned to amoxicillin, with planned duration of 3 months. Aggregetibacter aphrophilus is a low virulence HACEK group bacterial pathogen with potential to cause osteomyelitis.2 This case of an uncommon, low-virulence pathogen causing osteomyelitis shows the importance of aetiological diagnosis to guide appropriate management, especially in cases with indolent presentations. 1.Arnold JC, Bradley JS. Osteoarticular infections in children. Infect Dis Clin North Am 2015; 29: 557–74.2.Norskov-Lauritsen N, Kilian M. Reclassification of Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, Haemophilus paraphrophilus and Haemophilus segnis as Aggregatibacter actinomycetemcomitans gen. nov., comb. nov., Aggregatibacter aphrophilus comb. nov. and Aggregatibacter segnis comb. nov., and emended description of Aggregatibacter aphrophilus to include V factor-dependent and V factor-independent isolates. Int J Syst Evolutionary Microbiol 2006; 56: 2135–46.
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