Plexus Neuropathy in Infants Secondary to Arthro-Osteomyelitis: Report of 2 Cases and Review of the Literature

Abstract

If the brachial nerves are affected in arthro-osteomyelitis, a flaccid palsy may result. Pediatricians and pediatric orthopedists should remain alert to signs of brachial palsy due a humeral infection, as this condition must be recognized rapidly and treated adequately. The cases of two infants who showed brachial palsy secondary to arthro-osteomyelitis, one of whom was followed up for seven years, were reported. Similar cases described in the literature were reviewed. Clinical features, absence of movement, and absence of biceps and triceps reflexes, were suggestive of peripheral brachial neuropathy: EEG and NCV investigations confirmed the diagnosis of true neuropathy. Early antibiotic treatment in these children resulted in rapid clinical improvement. According to our results and those reported in the literature, in infancy brachial palsy secondary to artro-osteomyelitis is uncommon; signs or symptoms of arthro-osteomyelitis are often subtle and initially underestimated; arm flaccidity secondary to arthro-osteomyelitis may result in true paralysis (no pseudo-paralysis); invasive treatment may be prevented by a prompt diagnosis and antibiotic treatment. doi: http://dx.doi.org/10.4021/ijcp60w