Primary sternal osteomyelitis in a 40 days old infant: a case report and review of the literature

Abstract

IntroductionPrimary sternal osteomyelitis is extremely rare in children and only very few cases have been reported in the international literature.Case presentationA 40 days old Caucasian infant was referred to our clinic with a 4 days history of fever and malaise, accompanying a painful swelling of four days duration involving the lower end of the sternum. Examination revealed a 2 cm swelling which was fixed to the underlying bone. A full blood count, erythrocyte sedimentation rate, and C-reactive protein were measured and x-rays (Anterior and Lateral views) and Ultrasound was performed. Blood cultures were also taken. The patient was commenced empirically to Vancomycin and Cefotaxime intravenously.The values of White Blood Cell (16,720), erythrocyte sedimentation rate (132 mm) and C-reactive protein (108 mg/dl) were elevated, the X-rays showed bone destruction and dislocation of the 3rd sternal nuclei and in the U/S performed appeared a soft tissue mass measuring 2,37/1,02 cm related to the periosteum. Surgical debridement was then performed and swab cultures were taken intraoperatively. The infant grew Streptococcus Pneumoniae and Enterococcus Species. The infant was discharged after 25 days from the hospital. He gradually improved over a period of 2 months, became pain free and repeated x-rays showed significant bone resolution.ConclusionPrimary osteomyelitis in infants is a very rare condition that usually resolves with antibiotic therapy and surgical debridement.

Role of ultrasound and CT in the early diagnosis and surgical treatment of primary sternal osteomyelitis caused by Salmonella: Case reports

“…Osteomyelitis induced by a Salmonella strain is rarely reported in the literature ( 1 ). Staphylococcus aureus is the most common causative agent of osteomyelitis and osteomyelitis caused by Mycobacterium tuberculosi s is also found in endemic areas ( 2 ). Primary sternal osteomyelitis (PSO) caused by Salmonella is rare and has typically been associated with sickle cell disease, systemic lupus erythematosus, lymphoma and liver disease, occurring at the extremes of age ( 1 , 3 ).…”

Culture-negative primary sternal osteomyelitis in a patient with uncontrolled type 2 diabetes mellitus

“…Osteomyelitis is defined as destructive inflammation of bone due to infection, typically bacterial or fungal in nature [3] . Sternal osteomyelitis is a condition most commonly associated with sternal trauma or cardiac surgery, in which it is termed secondary sternal osteomyelitis [4] . PSO, on the other hand, is more rare and has no identifiable primary focus of infection [4] .…”

“…Sternal osteomyelitis is a condition most commonly associated with sternal trauma or cardiac surgery, in which it is termed secondary sternal osteomyelitis [4] . PSO, on the other hand, is more rare and has no identifiable primary focus of infection [4] . It is hypothesized that PSO arises via hematogenous seeding of the sternum during episodes of bacteremia [5] .…”

“…There have also been pediatric cases of idiopathic PSO caused by organisms other than S. aureus , including Streptococcus pneumoniae, Candida albicans , and Enterococcus sp. [ 4 , 15 ]. Interestingly, the patient described in our report had negative blood and bone biopsy cultures.…”

Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report

“…The primary form affects mainly young people and may be associated with intravenous drug use, trauma, or a central access catheter placed in the subclavian vein. The causative organisms are bacteria and, occasionally, fungi [2,3]. …”