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LETTER TO EDITOR |
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Year : 2018 | Volume
: 9
| Issue : 1 | Page : 40-41 |
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Multifocal osteomyelitis involving the clavicular bones
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
Date of Web Publication | 24-Jan-2018 |
Correspondence Address: Dr. Ibrahim Aliyu Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/mjmsr.mjmsr_29_17
How to cite this article: Aliyu I. Multifocal osteomyelitis involving the clavicular bones. Muller J Med Sci Res 2018;9:40-1 |
Dear Editor,
Osteomyelitis is an infection of the bone; this commonly involves the long bones such as that of the extremities; organisms commonly implicated are Staphylococcus aureus, Haemophilus influenzae type b, and Streptococcus pneumoniae, and in sickle-cell anemic patients, Salmonella More Details typhi have been implicated.[1] The bacterial profile of osteomyelitis in sickle-cell disease (SCD) has changed over the years, Ebong [1] in 1986 reported Salmonella osteomyelitis in 50% of case [1] while Thanni [2] reported S. aureus as the most common organism implicated in osteomyelitis among SCA patients in Nigeria; though SCD patients have a greater susceptibility to salmonella osteomyelitis worldwide; why this is so is not completely understood, however, SCD affects the opsonization and splenic immune protective function. A 7-year-old boy presented with fever, limb, and chest pain for 10 days; he was a diagnosed sickle-cell anemic patient who had been regular with his routine drugs and he had also received his routine vaccines. These complaints were associated with the upper chest [Figure 1] and both leg swellings; there was no history of difficulty in breathing, but he had worsening limb pains with attempted ambulation. He had an elevated white blood cell count of 35 × 109/L. The X-ray of the lower limbs and clavicles showed periosteal reaction on the medial ends of both clavicles and tibia and blood culture grew S. aureus. He made remarkable improvement after 3 weeks of antibiotic therapy. Multifocal osteomyelitis is uncommon in the general populace; however, Ebong [1] reported it in 42.6% of SCD patients; the lower limbs were mostly affected with symmetrical distribution while the tibia was the most affect bone; however, involvement of the clavicles was not reported.[1] Clavicular osteomyelitis is rare;[3],[4],[5] Chrysochoou et al.[6] reported it constituting <3% of cases of osteomyelitis in children. It may follow post-traumatic events, especially after subclavian catheter placement;[5],[6] furthermore, hematogenous spread has been implicated, as was observed in the index case. Few cases have been reported among sickle-cell anemic patients,[7] and the clinical features may be quite subtle with limited X-ray findings, and S. aureus is the most implicated organism, which was similar to our findings.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | |  |
1. | Ebong WW. Acute osteomyelitis in Nigerians with sickle cell disease. Ann Rheum Dis 1986;45:911-5.  [ PUBMED] |
2. | Thanni LOA. Bacterial osteomyelitis in major sickling haemoglobinopathies: Geographic difference in pathogen prevalence. Afr Health Sci 2006;6:236-9. |
3. | Gerscovich EO, Greenspan A. Osteomyelitis of the clavicle: Clinical, radiologic, and bacteriologic findings in ten patients. Skeletal Radiol 1994;23:205-10.  [ PUBMED] |
4. | Balakrishnan C, Vashi C, Jackson O, Hess J. Post-traumatic osteomyelitis of the clavicle: A case report and review of literature. Can J Plast Surg 2008;16:89-91.  [ PUBMED] |
5. | Saglam F, Saglam S, Gulabi D, Eceviz E, Elmali N, Yilmaz M, et al. Bilateral clavicle osteomyelitis: A case report. Int J Surg Case Rep 2014;5:932-5. |
6. | Chrysochoou EA, Antachopoulos C, Badekas K, Roilides E. A rare case of clavicle osteomyelitis in a child and literature review. Case Rep Pediatr 2016;2016:8252318.  [ PUBMED] |
7. | Al-Fifi SH, Al-Qahtani SM, Al-Binali AM, Annobil SH. An unusual complication of sternal and clavicle osteomyelitis in a child with sickle cell disease. Saudi Med J 2002;23:589-90.  [ PUBMED] |
[Figure 1]
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