Multiple bone and joint disease in a sickle cell anaemia patient: a case report

Abstract

This case highlights the fact that bone involvement is the commonest clinical manifestation of Sickle Cell Disease (SCD) both in the acute settings such as painful vaso-occlusive crisis (VOC) and as a source of chronic, progressive debility such as avascular necrosis (AVN), chronic osteomyelitis and fixed flexion deformity of joints.Protracted multiple bone involvement i.e. bilateral femoral and left humeral chronic osteomyelitis, Left elbow, Left knee and right humeral septic arthritis together with avascular necrosis of both femoral and right humeral heads, coupled with urinary tract infection (UTI) and decubitus ulcer in a young adult SCD patient is an unusual occurrence. This morbidities resulted into an uninterrupted 29 weeks of hospitalization for the patient who had previously enjoyed fairly good health.Various micro-organisms were sequentially cultured at various times and sites; these include E coli and Klebsiella in urine and klebsiella spp in the aspirates of the affected knee joint, elbow joint and femoral osteomyelitis. A screen for HIV 1 and 2 were non-reactive.Multidisciplinary approach was applied to the patient who was finally discharged home on a wheelchair. This case reflects not only the high susceptibility of SCD patients to infection, but also the morbidity and the attendant complications. It also highlights the need to forestall VOC which often predisposes to osteomyelitis. There is a need to have a highly organized, well-equipped and highly subsidized Sickle Cell and rehabilitation center in Nigeria in order to improve the medical care for SCD patients.

Septic Chronic Multifocal Osteomyelitis in Children: A Challenging Presentation of Osteomylitis in a Low Income Country

“…It occurs mostly in children from rural setting. Sickle cell anemia and malnutrition (which is common is rural population in our country) certainly explain chronic anemia responsible for decreased immunity, leading to multifocal bone involvement [6] [7] [8] [10].…”

“…Management of SCMO is a challenge for the medical team. Due to the complexity of the disease, care must be multidisciplinary, involving clinicians, radiologists and biologists [6]. Indeed, faced with an SCMO, several problems must be taken into account.…”

“…[6] [10].The characteristic surgical complications of SCMO is multiple bone defects (Figure 2) which is a real tragedy in limited resource setting like our hospital. In fact, these bone defects require reconstruction techniques that are not always available in Africa[10] [13][14].Despite a good treatment, evolution is not always favorable[7] [8].…”

“…[5] [6] [7]. A perfect knowledge of these septic chronic multifocal osteomyelitis (SCMO) could allow a better management.…”

Bilateral chronic osteomyelitis of the femur with intramedullary confined bulky

“…The bilateral forms are extremely rare [1]. Olaniyi in Nigeria [2] brought back a case with multiple osseous localizations with a bilateral femoral attack. A bilateral tibial attack due to Pantoea agglomerans was reported by Bachmeyer [3] at a SS homozygote drepanocytosis patient.…”