PRIMARY STERNAL OSTEOMYELITIS IN A CHILD: A CASE REPORT

Abstract

TYPE: Case Report TOPIC: Pediatrics INTRODUCTION: Primary sternal osteomyelitis which develop without any contiguous focus of infection is a rare condition, that too in children. MRI and biopsy are required for diagnosis. Rarity of the condition often results in delayed diagnosis and treatment. CASE PRESENTATION: A 9 year old boy , who was otherwise normal, presented with high fever - 9 days, followed by painful limitation of movement of right upper limb.O/E- Sick and toxic child..Tender, firm swelling, 2 x 2cm ,over the sterno-chondral junction of 2nd and 3rd rib with signs of inflammation.Rest of physical examination WNL. Investigation revealed anemia, polymorphonuclear leucocytosis with elevated ESR and CRP. Cultures were sterile. USG revealed collection below Rt sternoclavicular joint which yielded a dry tap . CECT showed non enhancing collection with no cortical defect in sternum. MRI revealed T2 hyperintensity and T1 hypointensity showing diffusion restriction of sternum suggestive of bone marrow edema.CT-guided sternal biopsy confirmed sternal osteomyelitis. Patient responded to Meropenem and Vancomycin after nonresponse to Cloxacillin and cefotaxime.Treatment continued for 4 weeks and patient recovered completely. DISCUSSION: Primary sternal osteomyelitis is diagnosed after exclusion of other sources of infection. Close proximity to vital organs can complicate the condition. Early recognition, identification of the causal organism, and early initiation of culture-driven intravenous antibiotic therapy is crucial in determining outcome. Staphylococcus aureus,coagulase negative staphylococcus, group B streptococcus, and other streptococcus species are most commonly implicated organisms.Nearly half requires surgical debridement and resection. CONCLUSIONS: Early diagnosis and appropriate treatment results in complete recovery of sternal osteomyelitis DISCLOSURE: Nothing to declare. KEYWORD: sternal osteomyelitis