title: Not by the Red on My Chinny Chin Chin: A Case of Mandibular Osteomyelitis in a 5-Year-Old Girl.
abstract: BACKGROUND
  Osteomyelitis is not an uncommon emergency department diagnosis in pediatric patients, and most cases are in the lower extremities. Children can present with acute, subacute, or chronic erythema, pain, swelling, or decreased use of the extremity; some patients will also have fever or elevated serum inflammatory markers, or both.
  
  
  METHODS
  We present the case of a healthy 5-year-old girl who presented to the emergency department with 3 weeks of painless chin swelling and 2 days of erythema and pain. While laboratory testing was normal, magnetic resonance imaging demonstrated osteomyelitis of the mandible, later confirmed by biopsy. After 4 weeks of intravenous antibiotics and an additional 2 weeks of oral antibiotics, the patient recovered completely without any residual findings. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates that osteomyelitis can develop in previously healthy, fully vaccinated children with competent immune systems. Systemic findings (ie, fever and elevated serum inflammatory markers) may be absent, and osteomyelitis should always be considered in the differential diagnosis for a child presenting with subacute to chronic cutaneous findings without other clear explanation.
authors.affiliation: Department of Emergency Medicine, Dell Children's Medical Center, Austin, Texas.
authors.forename: Dina
authors.initials: D
authors.lastname: Wallin
authors.affiliation: Department of Emergency Medicine, Dell Children's Medical Center, Austin, Texas.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kienstra
mesh_terms: D019980:Amoxicillin-Potassium Clavulanate Combination / Q000494:pharmacology / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001706:Biopsy / Q000379:methods; D002675:Child, Preschool; D002680:Chin / Q000002:abnormalities / Q000503:physiopathology* / Q000601:surgery; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology; D010019:Osteomyelitis / Q000175:diagnosis* / Q000503:physiopathology*; D011859:Radiography / Q000379:methods; D014463:Ultrasonography / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination
keywords: ENT; infectious disease; osteomyelitis; pediatrics; skin and soft tissue infection