Streptococcus viridans Pelvic Osteomyelitis after Dental Procedures in an Adolescent Male: A Case Report Illustrating the Importance of Dental History

Abstract

Pelvic osteomyelitis is a rare entity with a highly variable clinical presentation. Patients usually present with hip or groin pain, difficulty walking, and sometimes fever. In children, it can mimic septic arthritis of the hip, an acute abdomen, and an inguinal hernia, making it a diagnostic challenge for many physicians. Predisposing risk factors include immunodeficiency, intravenous drug abuse, pelvic or urologic surgery, and young age. A more unfamiliar predisposing factor is strenuous physical activity in athletes, suggesting the presence of osseous microtrauma occurring in the setting of excessive stress to the pelvis during exercise. Although the most common pathogen in osteomyelitis is Staphlyococcus aureus, other bacterial causes should be suspected based on the patient’s immune status and medical, dental and social history. This case highlights an unusual presentation of Streptococcus viridans osteomyelitis of the acetabulum in an otherwise healthy 13-year-old athletic male. The patient had undergone significant dental work prior to his symptom onset, which likely resulted in transient bacteremia and subsequent hematogenous seeding in areas of osseous microtrauma. Although exceedingly rare, Steptococcus viridans osteomyelitis has previously been reported in association with dental procedures. Osteomyelitis of the pelvis is an uncommon yet debilitating disease that should be included in the differential diagnosis of young athletes presenting with unexplained sudden onset hip or groin pain, atypical gait, painful range of motion of the hip, and fever. The novel bacterial etiology presented in this case should call attention to the association between dental procedures and Streptococcus viridans osteomyelitis. Dental history is commonly overlooked during many hospital medical evaluations, and we believe this case report should highlight the importance of obtaining a basic dental history, especially in patients presenting with signs and symptoms of pelvic osteomyelitis.