Pyomyositis, septic arthritis and acute osteomyelitis due to community methicillin-resistant Staphylococcus aureus in a pediatric patient

Abstract

Osteoarticular and musculoskeletal infections are relatively rare infectious diseases in childhood, generally affecting men and children under 5 years of age. Developed countries report an annual incidence of osteomyelitis of 10 to 80 / 100,000 children and 4 cases / 100,000 children for septic arthritis. In tropical countries, pyomyositis has an incidence of one case for every 2,000 inhabitants. Staphylococcus aureus is the main causative agent. In childhood the most common route of arrival of the germ to the joint is hematogenous. Up to 30% of children coexist acute osteomyelitis and septic arthritis. We present the case of a 3-year-old male preschooler who, after crushing his left lower limb, presented an increase in volume, pain, and limited gait, and was associated with a fever of 39.5 ° C 9 days later, going to the University Hospital of Caracas. The anamnesis, clinical evaluation and paraclinical studies were suggestive of pyomyositis of the left thigh, osteomyelitis of the left femur and septic arthritis of the left knee. Antibiotic therapy with coverage for Staphylococcus aureus (ciprofloxacin and clindamycin) is indicated. Evacuating arthrotomy and surgical cleaning of affected structures were performed. The culture reported Staphylococcus aureus sensitive to ciprofloxacin, gentamicin, linezolid, rifampin, trimetropin / sulfamethoxazole; resistant to clindamycin, erythromycin, oxacillin, therefore clindamycin was omitted and trimetropin / sulfamethoxazole was indicated. He completed 21 days of intravenous treatment, observing satisfactory evolution so his discharge was decided, continuing with oral treatment for four weeks and interdisciplinary follow-up. The timely and adequate approach to these pathologies reduces the risk of developing complications.