Clerc Axelle, Zeller Valerie, Marmor Simon, Senneville Eric, Marchou Bruno, Laurent Frederic, Lucht Frederic, Desplaces Nicole, Lustig Sebastien, Chidiac Christian, Ferry Tristan
Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon - Hôpital de la Croix-Rousse Lyon, Cedex 04.
Université Claude Bernard 1, Lyon.
Medicine (Baltimore). 2020 May;99(20):e19617. doi: 10.1097/MD.0000000000019617.
To describe the epidemiological, clinical, laboratory, and radiological features and the management of adult patients who experienced a relapse between 2003 and 2015 of an acute hematogenous osteomyelitis acquired in childhood.A retrospective multicentric cohort study was conducted in 5 centers in France.Thirty-seven patients were included. The median age was 40 years (28-56), and 26 (70%) were male. The first site of infection was the distal femur (n = 23, 62%). The median time between the osteomyelitis in childhood and the relapse in adulthood was 26 years (13-45). Thirty-four (92%) patients reported inflammatory local clinical manifestations, 17 (46%) draining fistula, 10 (27%) fever. Most patients had intramedullary gadolinium deposition (with or without abscess) on magnetic resonance imaging. Most relapses were monomicrobial infections (82%). Staphylococcus aureus was the most commonly found microorganism (82%), expressing a small colony variant phenotype in 3 cases. Most patients (97%) had a surgical treatment, and the median duration of antibiotics for the relapse was 12 weeks. All patients had a favorable outcome, no patient died and no further relapse occurred. We count 2 femoral fractures on osteotomy site.Osteomyelitis in childhood can relapse later in adulthood, especially in patients with lack of care during the initial episode. Osteotomy and prolonged antimicrobial therapy are required for clinical remission.
描述2003年至2015年间童年期获得性急性血源性骨髓炎复发的成年患者的流行病学、临床、实验室及影像学特征和治疗情况。在法国的5个中心开展了一项回顾性多中心队列研究。纳入37例患者。中位年龄为40岁（28 - 56岁），26例（70%）为男性。感染的首发部位是股骨远端（n = 23，62%）。童年期骨髓炎与成年期复发之间的中位时间为26年（13 - 45年）。34例（92%）患者报告有局部炎症临床表现，17例（46%）有引流瘘管，10例（27%）发热。多数患者在磁共振成像上有髓内钆沉积（伴或不伴脓肿）。多数复发为单一微生物感染（82%）。金黄色葡萄球菌是最常见的微生物（82%），3例表现为小菌落变异表型。多数患者（97%）接受了手术治疗，复发时抗生素治疗的中位疗程为12周。所有患者预后良好，无患者死亡，也未发生进一步复发。我们在截骨部位发现2例股骨骨折。童年期骨髓炎可在成年后期复发，尤其是初次发作时未得到妥善治疗的患者。截骨术和延长抗菌治疗是临床缓解所必需的。
