Bilateral Tibial Chronic Osteomyelitis in a Non-Sickler: A Case Report and Review of Literature

Abstract

BACKGROUND: Osteomyelitis in children has various clinical manifestations causing diagnostic and therapeutic difficulties. Inappropriate treatment of acute osteomyelitis may lead to a more chronic, serious and complicated form. Chronic osteomyelitis continues to be a major cause of morbidity and disability in children especially those living in developing countries.

OBJECTIVE: To present a case of bilateral tibial chronic osteomyelitis in a non-sickler and review the literature on the subject.

METHODS: An 8 year old boy presented with a 23-day history of high grade intermittent fever and a 22-day history bilateral leg swelling. Detailed history was obtained and physical examination carried out. He was further evaluated with laboratory and radiological investigations and received adequate treatment before he was discharged home.

RESULTS: He had periodic bouts of fever which was unresponsive to anti-pyretics. His legs were swollen and tender with inability to stand. Investigations revealed anaemia, leucocytosis, neutropenia, lymphocytosis and raised  Erythocyte Sedimentation Rate of 128mm/hour. Soft tissue swelling around the tibia was seen on the radiograph. He had incision and drainage done on both legs with wounds packed and dressed. The drained purulent fluid was sent for microscopy, culture and sensitivity and it revealed growth of Staph. aureus sensitive to azithromycvin, genticin and ofloxacin. He was principally treated with antibiotics, analgesics and hematinics which yielded a good result.

CONCLUSION: Multiple bone chronic osteomyelitis occurs in non sickle cell disease patients who are immune competent.  It can also be treatable simple incision and drainage of the soft tissue abscess and appropriate antibiotics, without classical bone operative procedures if diagnosed early, with a good outcome.

Keywords: Osteomyelitis, Chronic Osteomyelitis, Multiple Bone infections, Non-sickle cell patient.