Saadana Jacem, Lassioued Oussama, Abid Said, Ben Mansour Maha, Abid Abderrazek
Orthopaedics and Traumatology, Fattouma Bourguiba University Hospital, Monastir, TUN.
Anesthesiology and Reanimation, Fattouma Bourguiba University Hospital, Monastir, TUN.
Cureus. 2023 Feb 24;15(2):e35429. doi: 10.7759/cureus.35429. eCollection 2023 Feb.
Acute hematogenous osteomyelitis (AHO) commonly interests the pediatric population. It typically affects the metaphyses of long tubular bones. However, the fibula is rarely involved. Regarding the hematogenous inoculation, this infection may be associated with distant foci. Herein, we present the case of a 10-year-old girl who was initially diagnosed with atypical AHO of the distal fibula complicated by a subperiosteal abscess. Upon admission, the child showed a severe septic condition, including embolic infective endocarditis (IE), which was responsible for multiple cerebral, renal, and splenic loci. AHO was successfully resolved with appropriate intravenous antimicrobial treatment targeting Staphylococcus aureus, surgical drainage, and debridement. Due to the complexity of the lesions and the embolic nature, the IE was also managed operatively with a mechanical prosthesis. The distal fibula is a rare and challenging location for AHO. EI co-infection should always be sought and suspected because, in such instances, it will genuinely complicate diagnostic and therapeutic management.
急性血源性骨髓炎（AHO）常见于儿童群体。它通常影响长管状骨的干骺端。然而，腓骨很少受累。关于血源性接种，这种感染可能与远处病灶有关。在此，我们报告一例10岁女孩的病例，她最初被诊断为远端腓骨非典型AHO并伴有骨膜下脓肿。入院时，患儿表现出严重的脓毒症状态，包括栓塞性感染性心内膜炎（IE），这导致了多个脑、肾和脾部位的病变。通过针对金黄色葡萄球菌的适当静脉抗菌治疗、手术引流和清创，AHO得以成功治愈。由于病变的复杂性和栓塞性质，IE也通过机械假体进行了手术治疗。远端腓骨是AHO的一个罕见且具有挑战性的发病部位。应始终寻找并怀疑存在IE合并感染，因为在这种情况下，它会真正使诊断和治疗管理复杂化。
