Pettas Nikolaos S, Apostolopoulos Alexandros P, Flieger Ioannis, Leonidou Omiros
1st Orthopaedic Department, Agia Sofia Children’s Hospital, Athens, Greece.
Cases J. 2009 Jun 5;2:7504. doi: 10.4076/1757-1626-2-7504.
Primary sternal osteomyelitis is extremely rare in children and only very few cases have been reported in the international literature.
A 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 3(rd) 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.
Primary osteomyelitis in infants is a very rare condition that usually resolves with antibiotic therapy and surgical debridement.
原发性胸骨骨髓炎在儿童中极为罕见，国际文献中仅报道了极少数病例。
一名40天大的白种人婴儿因发热和不适4天，伴有胸骨下端持续4天的疼痛性肿胀，被转诊至我院。检查发现一个2厘米的肿胀，与下方骨骼相连。进行了全血细胞计数、红细胞沉降率和C反应蛋白检测，并拍摄了X线片（正位和侧位）及超声检查。同时采集了血培养样本。患者经验性地开始静脉注射万古霉素和头孢噻肟。白细胞计数（16,720）、红细胞沉降率（132毫米）和C反应蛋白（108毫克/分升）升高，X线片显示第3胸骨核骨破坏和脱位，超声检查显示一个与骨膜相关的2.37/1.02厘米的软组织肿块。随后进行了手术清创，并在术中采集了拭子培养样本。婴儿培养出肺炎链球菌和肠球菌属。婴儿在住院25天后出院。在2个月的时间里逐渐好转，疼痛消失，复查X线片显示骨质明显修复。
婴儿原发性骨髓炎是一种非常罕见的疾病，通常通过抗生素治疗和手术清创得以解决。
