Abstract
Introduction: Sickle cell hemoglobinopathy is a frequent cause of morbidity mostly in terms of vaso-occlusive crises and osteomyelitis, treatment of which is demanding as there is no set protocol to date designed for this subset of patients. Case Report: We report a case of a 14-year-old sickle cell boy who presented to us with chronic osteomyelitis involving the distal aspect of right radius and in whom the infection was successfully eradicated using multimodal treatment regimen which included a course of intravenous (IV) antibiotics along with surgical debridement and implantation of local antibiotic delivery system followed by appropriate course of oral antibiotics. Conclusion: Complete eradication of chronic osteomyelitis infection in a sickle cell patient represents challenge due to the pathophysiology of the disease which is significantly different in the patients. To our knowledge, this is the first reported case of such a combination therapy in pediatric sickle cell population in particular the usage of local antibiotic therapy in the form of cement beads which resulted in successful resolution of the osteomyelitis infection. Though this case alone does not provide sufficient proof but it does validate the concept of usage of multimodal therapy for treatment of similar infections in sickle cell population for further analytical studies.
Highlights
Sickle cell hemoglobinopathy is a frequent cause of morbidity mostly in terms of vaso-occlusive crises and osteomyelitis, treatment of which is demanding as there is no set protocol to date designed for this subset of patients
We present an interesting case of a 14-year-old boy, known case of sickle cell disease, who initially presented with a three weeks history of right forearm swelling and pain following a minor trauma
Lab investigations in terms of inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were requested and an ultrasound was done to rule out any underlying collection and revealed a 4 × 1.9 cm collection (Figure 2) in the distal radius for which he underwent incision and drainage and was started on IV antibiotics according to his previous positive blood cultures
Summary
The incidence of sickle cell disease is constantly decreasing due to an effective screening program in Bahrain, sickle cell disease remains the most common hemoglobinopathy affecting the inherited population of Bahrain with a reported incidence of 0.4% [1]. Radiographs repeated eight weeks postdischarge showed complete healing of the structural defect with no evidence of sequestrum (Figure 5), complete resolution of infection was supported by normal blood inflammatory markers His CRP upon follow-up was 5.35 and ESR was down to 1. Lab investigations in terms of inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were requested and an ultrasound was done to rule out any underlying collection and revealed a 4 × 1.9 cm collection (Figure 2) in the distal radius for which he underwent incision and drainage and was started on IV antibiotics (vancomycin and Rocephin) according to his previous positive blood cultures (salmonella).
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