Masuka Josiah T, Troisi Katherine, Mkhize Zamambo
Department of Dermatology, Nelson R Mandela School of Medicine, Private Bag X7, Congella, Durban, 4013, South Africa.
Department of Dermatology, Edendale Hospital, 89 Selby Msimang Rd, Pleissislaer, Pietermaritzburg, 3201, South Africa.
BMC Dermatol. 2020 Feb 3;20(1):2. doi: 10.1186/s12895-019-0098-0.
Atopic eczema is a relapsing, itchy chronic cutaneous inflammatory disease that commonly affects children. The disease is often complicated by cutaneous infections such as eczema herpeticum, eczema vaccinatum and a varied number of bacterial infections - impetigo, cellulitis and erysipelas. However, rare case reports of infective endocarditis, otitis media and osteo-articular infections have been associated with atopic eczema. These associations possibly represent the extracutaneous infectious complications of atopic eczema.
Here we present two cases of osteomyelitis in HIV negative children with habitual scratching of poorly managed and/or uncontrolled atopic eczema respectively. Both cases presented to the orthopaedic surgeons and were admitted as acute phalangeal osteomyelitis and acute - on - chronic tibial osteomyelitis respectively. The first case was an 8 year old girl who had moderate-severe poorly-controlled atopic eczema and contiguously spread phalangeal osteomyelitis. The second case was an 11 year old pre-pubertal boy who had untreated atopic eczema and tibial osteomyelitis possibly from haematogenously spread Staphylococcus aureus infection. Both were successfully discharged from hospital and currently have well controlled eczema. The 11 year old patient is also being reviewed monthly by the orthopaedic surgeons and is chronic suppressive antibiotics. He may require sequestrectomy, should it be needed.
Invasive staphylococcal and streptococcal osteo-articular (OA) infection can arise as an extra-cutaneous infectious complication of poorly controlled atopic eczema. It is more common in the 3 to 15 year age group and especially in boys with a septic arthritis to osteomyelitis ratio of around 29:5. Clinicians should maintain a high index of suspicion in patients with moderate-severe atopic eczema and they ought to promptly manage these OA infections with intravenous antibiotics to avoid further complications.
特应性皮炎是一种复发性、瘙痒性慢性皮肤炎症性疾病，常见于儿童。该疾病常并发皮肤感染，如疱疹样湿疹、种痘样湿疹以及多种细菌感染——脓疱病、蜂窝织炎和丹毒。然而，感染性心内膜炎、中耳炎和骨-关节感染的罕见病例报告与特应性皮炎有关。这些关联可能代表了特应性皮炎的皮肤外感染并发症。
在此，我们分别介绍两例HIV阴性儿童骨髓炎病例，他们均有习惯性搔抓行为，且特应性皮炎管理不善和/或控制不佳。两例均被骨科医生收治，分别被诊断为急性指骨骨髓炎和慢性期急性胫骨骨髓炎。第一例是一名8岁女孩，患有中度至重度控制不佳的特应性皮炎，指骨骨髓炎呈连续性扩散。第二例是一名11岁青春期前男孩，特应性皮炎未经治疗，胫骨骨髓炎可能由血行播散的金黄色葡萄球菌感染引起。两人均顺利出院，目前湿疹得到良好控制。11岁患者也每月接受骨科医生复查，并接受长期抑制性抗生素治疗。如有需要，他可能需要进行死骨切除术。
侵袭性葡萄球菌和链球菌骨-关节（OA）感染可能作为控制不佳的特应性皮炎的皮肤外感染并发症出现。在3至15岁年龄组中更为常见，尤其是男孩，脓毒性关节炎与骨髓炎的比例约为29:5。临床医生应对中度至重度特应性皮炎患者保持高度怀疑，并应及时用静脉抗生素治疗这些OA感染，以避免进一步并发症。
