[Osteomyelitis in children: sometimes hard to recognize].
In a 15-year-old girl with pain in the right lower abdomen and a 9-year-old boy with pain in the left thigh, an elevated sedimentation rate and C-reactive protein were reason to suspect osteomyelitis. Although no abnormalities could be seen on X-rays, skeletal scintigraphy revealed pathology in Liv-v and the sacroiliac joint, respectively. In the girl, Staphylococcus aureus was cultivated from material obtained by puncture and biopsy. After treatment with antibiotics, rest and gradual mobilisation, the girl retained a scoliosis; the boy was cured without residual complaints or abnormalities. Osteomyelitis of the spine and sacroiliac joint are rare disorders in children. The subtle and non-specific symptoms sometimes make the diagnosis difficult. Conventional X-ray is the primary radiological investigation. Bone scintigraphy (99mTc-oxidronate) is useful in the initial evaluation of children with suspected osteomyelitis. It is sensitive, relatively inexpensive, often does not require sedation and can detect multiple foci of disease. MRI is also highly sensitive and more specific than bone scintigraphy, but it cannot be used as a screening technique when the site of pathology is unclear. MRI is useful when the bone scintigram is inconclusive and in complicated cases for better anatomic details.
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Leids Universitair Medisch Centrum, Willem-Alexander Kinder- en Jeugdcentrum, Postbus 9600, 2300 RC Leiden.
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D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011379:Prognosis; D011877:Radionuclide Imaging; D012446:Sacroiliac Joint; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis*; D013669:Technetium Tc 99m Medronate; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D013669:Technetium Tc 99m Medronate