Division of Hematology, Children's National Health System, Washington, DC.
The George Washington University School of Medicine and Health Sciences, Washington, DC.
Pediatr Blood Cancer. 2020 May;67(5):e28225. doi: 10.1002/pbc.28225. Epub 2020 Feb 17.
Patients with sickle cell disease (SCD) are at increased risk for osteomyelitis (OM). Diagnosis of OM in SCD is challenging as the clinical presentation is similar to a vasoocclusive crisis (VOC) with no diagnostic gold standard. We report characteristics and outcomes of OM in SCD patients treated at our center over 10-year period.
DESIGN/METHOD: We conducted a retrospective analysis of patients with SCD who were treated for OM at our center over a 10-year period (2006-2016). Cases were identified utilizing radiology data mining software. Radiology reports and medical charts of potential OM cases were reviewed.
Twenty-eight children with SCD were treated for OM at our institution. Patients treated for OM were largely similar to patients treated for a VOC. However, patients treated for OM had significantly higher C-reactive protein (10 mg/dL vs 5.58 mg/dL, P = 0.03) and erythrocyte sedimentation rate (60 mm/h vs 47 mm/h, P = 0.02). Magnetic resonance imaging (MRI) findings were consistent with OM in 18 (64%) patients and indeterminate in the remaining. Based on clinical, laboratory, and radiological findings, the diagnosis of OM was considered confirmed in 3 patients, probable in 6 patients, and presumed in 19 patients. Nontyphoidal Salmonella was isolated from cultures in 9 (32%) patients, while no organism was identified in 19 (67%) patients. All patients were treated with antibiotics. Six patients (21%) required surgical interventions.
OM continues to pose diagnostic challenges. Most patients are treated for OM without definitive confirmation. Nontyphoidal Salmonella was the only organism identified in our cohort.
镰状细胞病（SCD）患者发生骨髓炎（OM）的风险增加。SCD 患者 OM 的诊断具有挑战性，因为其临床表现与血管阻塞性危象（VOC）相似，而无诊断金标准。我们报告了在我们中心治疗的 SCD 患者 OM 的特征和结局，时间跨度为 10 年。
我们对在我们中心治疗的 10 年（2006-2016 年）期间患有 OM 的 SCD 患者进行了回顾性分析。使用放射学数据挖掘软件来识别病例。回顾了潜在 OM 病例的放射学报告和病历。
在我们机构，有 28 名 SCD 患儿因 OM 接受了治疗。接受 OM 治疗的患者与接受 VOC 治疗的患者大致相似。然而，接受 OM 治疗的患者的 C 反应蛋白（10mg/dL 比 5.58mg/dL，P=0.03）和红细胞沉降率（60mm/h 比 47mm/h，P=0.02）显著更高。18 名（64%）患者的 MRI 结果与 OM 一致，其余患者结果不确定。根据临床、实验室和影像学结果，OM 的诊断被认为确诊 3 例、可能 6 例、疑似 19 例。9 名（32%）患者的培养物中分离出非伤寒沙门氏菌，而 19 名（67%）患者未鉴定出任何病原体。所有患者均接受抗生素治疗。6 名患者（21%）需要手术干预。
OM 仍然存在诊断挑战。大多数患者接受 OM 治疗而未明确确诊。非伤寒沙门氏菌是我们队列中唯一鉴定出的病原体。
