Visual Diagnosis in Emergency Medicine| Volume 45, ISSUE 4, P609-611, October 2013

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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        • Kaplan S.L.
        Osteomyelitis in children.
        Infect Dis Clin North Am. 2005; 19 (vii): 787-797
        • Hatzenbuehler J.
        • Pulling T.J.
        Diagnosis and management of osteomyelitis.
        Am Fam Physician. 2011; 84: 1027-1033
        • Dartnell J.
        • Ramachandran M.
        • Katchburian M.
        Haematogenous acute and subacute paediatric acute osteomyelitis.
        J Bone Joint Surg Br. 2012; 94-B: 584-595
        • Peltola H.
        • Vahvanen V.
        A comparative study of osteomyelitis and purulent arthritis with special reference to aetiology and recovery.
        Infection. 1984; 12: 75-79
        • Boutin R.D.
        • Brossmann J.
        • Sartoris D.J.
        • Reilly D.
        • Resnick D.
        Update on imaging of orthopedic infections.
        Orthop Clin North Am. 1998; 29: 41-66
        • Littenberg B.
        • Mushlin A.I.
        Technetium bone scanning in the diagnosis of osteomyelitis: a metaanalysis of test performance. Diagnostic Technology Assessment Consortium.
        J Gen Intern Med. 1992; 7: 158-164
        • Meyers S.P.
        • Wiener S.N.
        Diagnosis of hematogenous pyogenic vertebral osteomyelitis by magnetic resonance imaging.
        Arch Intern Med. 1991; 151: 683-687
        • Cole W.G.
        • Dalziel R.E.
        • Leitl S.
        Treatment of acute osteomyelitis in childhood.
        J Bone Joint Surg Br. 1982; 64: 218-223
        • Dirschl D.R.
        • Almekinders L.C.
        Osteomyelitis. Common causes and treatment recommendations.
        Drugs. 1993; 45: 29-43
        • Cierny G.
        • Mader J.T.
        The surgical treatment of adult osteomyelitis.
        in: Surgery of the musculoskeletal system. Vol. 4. Churchill Livingstone, New York1983: 15-35
        • Mader J.T.
        • Ortiz M.
        • Calhoun J.H.
        Update on the diagnosis and management of osteomyelitis.
        Clin Podiatr Med Surg. 1996; 13: 701-724
        • Lew D.P.
        • Waldvogel F.A.
        N Engl J Med. 1997; 336: 999-1007
        • Howman-Giles R.
        • Uren R.
        Multifocal osteomyelitis in childhood. Review by radionuclide bone scan.
        Clin Nucl Med. 1992; 17: 274-278