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Acute Multifocal Osteomyelitis in an Infant

      A 3-month-old boy was referred to the Emergency Department for concern of nonaccidental trauma due to a several-week history of not using the right arm, avoidance of breastfeeding on the right side, and absence of fever. He was accompanied by both parents and his grandmother. There was no history of trauma or septic risk factors. The remainder of the history was noncontributory, including a negative maternal group B streptococcus status. On examination, the patient was afebrile with normal vital signs. There was no obvious swelling, redness, or deformity of the right shoulder. There was no active mobility about the right shoulder joint and passive range of motion appeared painful. The remainder of physical examination was unremarkable. An x-ray study of the right shoulder was performed, which confirmed the diagnosis (Figure 1).
      Figure thumbnail gr1
      Figure 1Anteroposterior x-ray study of right shoulder demonstrates subluxation of the humerus in relation to the glenohumeral joint. There is associated area of metaphyseal erosion medially and extending over a distance of 1.06 cm, consistent with osteomyelitis (arrow).
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